title: Magnesium Sulphate for Eclampsia and Fetal Neuroprotection: A Comparative Analysis of Protocols Across Canadian Tertiary Perinatal Centres.
abstract: BACKGROUND
  Magnesium sulphate (MgSO4) has been recommended for fetal neuroprotection to prevent cerebral palsy, with national societies adopting new guidelines for its use. A knowledge translation project to implement Canadian guidelines is ongoing. Discussion about MgSO4 for fetal neuroprotection could not occur distinct from MgSO4 for eclampsia prophylaxis and treatment. Thus, in order to explore standardization of MgSO4 use in Canada, we sought to compare local protocols for eclampsia and fetal neuroprotection across tertiary perinatal centres.
  
  
  METHODS
  Twenty-five Canadian tertiary perinatal centres were asked to submit their protocols for use of MgSO4 for eclampsia prophylaxis/treatment and fetal neuroprotection. Information abstracted included date of protocol, definitions of indications for treatment, details of MgSO4 administration, maternal and fetal monitoring, antidote for toxicity, and abnormal signs requiring physician attention. Descriptive analyses were used to compare site protocols with known definitions of preeclampsia. Data from the Canadian Perinatal Network (CPN) were used to verify what was done in clinical practice.
  
  
  RESULTS
  Twenty-two of the 25 centres submitted protocols for eclampsia prevention/treatment. Eleven of these provided a definition of preeclampsia that warranted treatment; five of the 22 advised treatment of severe preeclampsia only. Criteria for treatment and monitoring procedures varied across centres. Sixteen of the 22 sites with protocols had data from the CPN. Of 635 women with pre-eclampsia, 422 (66.5%) received MgSO4. Twenty of 25 centres provided protocols for fetal neuroprotection. Definitions of indications were consistent across sites, except for gestational age cut-off.
  
  
  CONCLUSIONS
  This study suggests that local protocols are often inconsistent with published evidence. While this may be related to local institutional practices, relevant processes must be put in place to maximize uniformity of practice and improve patient care.
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute, University of British Columbia, Vancouver BC.
authors.forename: Dane A
authors.initials: DA
authors.lastname: De Silva
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
authors.forename: Diane
authors.initials: D
authors.lastname: Sawchuck
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute, University of British Columbia, Vancouver BC.
authors.forename: Peter
authors.initials: P
authors.lastname: von Dadelszen
authors.affiliation: Children's and Women's Health Centre of British Columbia, Vancouver BC.
authors.forename: Melanie
authors.initials: M
authors.lastname: Basso
authors.affiliation: Child and Family Research Institute, University of British Columbia, Vancouver BC; Department of Pediatrics, University of British Columbia, Vancouver BC.
authors.forename: Anne R
authors.initials: AR
authors.lastname: Synnes
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Liston
authors.affiliation: Child and Family Research Institute, University of British Columbia, Vancouver BC; Department of Medicine, University of British Columbia, Vancouver BC; Department of Medicine, British Columbia Women's Hospital and Health Centre, Vancouver BC.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Magee
mesh_terms: D002170:Canada / Q000453:epidemiology; D002985:Clinical Protocols / Q000592:standards*; D032921:Consensus; D004461:Eclampsia / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D008278:Magnesium Sulfate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018696:Neuroprotective Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018743:Perinatal Care / Q000592:standards*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D015149:Tocolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D018696:Neuroprotective Agents; D015149:Tocolytic Agents; D008278:Magnesium Sulfate
keywords: Magnesium sulphate eclampsia; eclampsia; fetal neuroprotection; preeclampsia; protocol