Intramuscular and intravenous routes of magnesium sulfate in preeclamptic with severe features transferred from community hospitals: a retrospective cohort

Abstract

OBJECTIVE

To compare the therapeutic level of the two routes of magnesium sulfate (MgSO4) treatment; intramuscular (IM) and intravenous (IV), in the preeclamptic patients during the transfer process from community hospitals to the obstetrics care center, especially in low or high maternal weight group.

METHODS

This retrospective cohort study aimed to compare the rate of the therapeutic level achievement of serum magnesium levels in preeclamptic women with severe features with the two routes of MgSO4; IM and IV, from the community hospitals before transferring to the obstetrics care center at Udonthani Hospital, Thailand. Serum magnesium level at admission and 4 hours at Udon Thani Hospital was taken. The rate of therapeutic serum Mg level achievement, sub-therapeutic, supra-therapeutic level, and adverse effects were also compared between the two routes.

RESULTS

Of these 754 preeclamptic patients with severe features, 285 in the IM group and 469 in the IV group. There were 58.3% of the women in the IM group achieved the therapeutic level compared with 22.2% in the IV group (adjusted odds ratio (AOR) 4.23; 95% confidence interval (CI) 3.01 to 5.94). For the subgroup analysis regarding body weight (BW), those with BW less than 60 kg, 79.3% of the IM group compared with 47.4% in the IV group (AOR 4.01; 95% CI 1.32 to12.2) achieved the therapeutic level; those with BW 60 to 79 kg, 66.7% in the IM group compared with 22.8% in the IV group (AOR 5.48; 95% CI 3.40 to 8.81) achieved the therapeutic level; those with BW 80 to 99 kg, 43.0% in the IM group compared with 15.6% in the IV group (adjusted OR 4.97; 95%CI 2.50 to 9.89) achieved the therapeutic level; and fort those with BW more than 100 kg, 30.0% in the IM group compared with 0% in the IV group achieved the therapeutic level.

CONCLUSION

IM route of MgSO4 was associated with higher rate of therapeutic level achievement than that of the IV route in MgSO4 regimen in preeclamptic women with severe features.