title: Nonreceipt of antenatal magnesium sulphate for fetal neuroprotection at the Women's and Children's Hospital, Adelaide 2010-2013.
abstract: BACKGROUND
  Australian and New Zealand clinical practice guidelines, endorsed by the NHMRC in 2010, recommend administration of antenatal magnesium sulphate to women at risk of imminent preterm birth at less than 30 weeks' gestation to reduce the risk of their very preterm babies dying or having cerebral palsy. The purpose of the ongoing Working to Improve Survival and Health for babies born very preterm (WISH) implementation project is to monitor and improve the uptake of this neuroprotective therapy across Australia and New Zealand.
  
  
  OBJECTIVE
  To quantify and explore reasons for nonreceipt of antenatal magnesium sulphate at the Women's and Children's Hospital, in Adelaide, South Australia.
  
  
  METHODS
  Data from the case records of women who gave birth between 23(+0) and 29(+6) weeks' gestation from 2010 to mid-2013 were reviewed to determine the proportion of eligible mothers not receiving antenatal magnesium sulphate and to explore reason(s) for nonreceipt over this time period.
  
  
  RESULTS
  There was a reduction in the proportion of eligible mothers not receiving antenatal magnesium sulphate from 2010 (69.7%) to 2011 (26.9%), which was maintained in 2012 and 2013 (22.5%). In 2012-2013, nonreceipt was predominantly associated with immediately imminent (advanced labour, rapid progression of labour) or indicated emergent birth (actual or suspected maternal or fetal compromise).
  
  
  CONCLUSIONS
  Use of antenatal magnesium sulphate at the Women's and Children's Hospital is now predominantly in-line with the binational guideline recommendations. Ongoing education and enhanced familiarity with procedures may facilitate timely administration in the context of some precipitous or immediately imminent births.
authors.affiliation: Women's and Children's Hospital, Adelaide, Australia.|Australian Research Centre for Health of Women and Babies, Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia.
authors.forename: Kasia
authors.initials: K
authors.lastname: Siwicki
authors.affiliation: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia.
authors.forename: Emily
authors.initials: E
authors.lastname: Bain
authors.affiliation: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia.
authors.forename: Tanya
authors.initials: T
authors.lastname: Bubner
authors.affiliation: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia.
authors.forename: Pat
authors.initials: P
authors.lastname: Ashwood
authors.affiliation: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia.
authors.forename: Philippa
authors.initials: P
authors.lastname: Middleton
authors.affiliation: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia.|Liggins Institute, The University of Auckland, Auckland, New Zealand.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Crowther
mesh_terms: D000328:Adult; D002547:Cerebral Palsy / Q000517:prevention & control; D002585:Cesarean Section; D005260:Female; D005316:Fetal Distress / Q000175:diagnosis; D005865:Gestational Age; D019983:Guideline Adherence / Q000639:trends*; D006771:Hospitals, Maternity / Q000592:standards / Q000639:trends*; D006776:Hospitals, Pediatric / Q000592:standards / Q000639:trends*; D006801:Humans; D007745:Labor Onset; D008278:Magnesium Sulfate / Q000008:administration & dosage*; D008485:Medical Audit; D010298:Parity; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D047928:Premature Birth / Q000188:drug therapy*; D013021:South Australia; D015149:Tocolytic Agents / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D015149:Tocolytic Agents; D008278:Magnesium Sulfate
keywords: cerebral palsy; clinical audit; magnesium sulphate; pregnancy; preterm birth