Premium
Magnesium sulfate titration reduces maternal complications following fetoscopic closure of spina bifida
Author(s) -
Lehoczky Lucy,
Southworth Annie B.,
Zamudio Martínez Gabriela,
Belfort Michael A.,
Shamshirsaz Alireza A.,
Shamshirsaz Amir,
Sanz Cortes Magdalena,
Nassr Ahmed A.,
Donepudi Roopali,
Whitehead William E.,
Johnson Rebecca,
Meshinchi Nazli,
Espinoza Jimmy
Publication year - 2021
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.5923
Subject(s) - medicine , regimen , spina bifida , anesthesia , surgery , obstetrics
Objective To evaluate if magnesium sulfate (MgSO 4 ) titration following fetoscopic spina bifida closure is associated with fewer maternal complications than the Management of Myelomeningocele Study (MOMS) tocolytic regimen. Methods This prospective cohort study included 73 consecutive patients undergoing fetoscopic closure of spina bifida between 2015 and 2020. A policy of using the MgSO 4 regimen per the MOMS trial was changed to a flexible one in which MgSO 4 was titrated according to the frequency of the uterine contractions following surgery. The frequency of maternal pulmonary edema, low maternal oxygen saturation requiring oxygen supplementation, atelectasis, hypocalcemia, and preterm delivery was compared before and after the policy was changed. Results A higher proportion of women in the group that used the MOMS MgSO 4 regimen had pulmonary edema compared to those in the flexible one (26.1% [6/23] vs. 6% [3/50]; p = 0.024). Multivariate analysis showed that the MOMS tocolytic regimen was independently associated with a higher risk of pulmonary edema (adjusted odds ratio: 8.57; 95% confidence interval: 1.54–47.7; p = 0.014) than a flexible one. There was no difference in the rate of preterm delivery. Conclusion Following fetoscopic closure of spina bifida, the MOMS MgSO 4 regimen is associated with an increased risk of pulmonary edema than a more flexible regimen.