Approximately half of the more than 500,000 preterm births each year result from preterm labor. Tocolytic therapy continues to be the focus of treatment of these women. Although a variety of tocolytics are used in clinical practice, magnesium sulfate remains one of the most commonly used agents. Magnesium sulfate has also been the focus of recent research for its potential neuroprotective effects for neonates born preterm. Evaluation of 19 randomized clinical trials reveals that magnesium sulfate tocolysis does not reduce the frequencies of delivery within 48 hours, 7 days, or early/late preterm birth, and is not associated with improvements in newborn morbidities or mortality. No other tocolytic class resulted in improved newborn outcomes when compared with magnesium sulfate tocolysis. We conclude that it is appropriate to withhold tocolysis with magnesium sulfate or other agents from women presenting in preterm labor as newborn benefit has not been demonstrated with such treatment. If initiated to achieve time for antenatal corticosteroid administration, or for other acute reasons, treatment can be discontinued once these goals have been achieved or if labor subsides before then. Because brief pregnancy prolongation is unlikely to improve newborn outcomes after corticosteroid administration has been completed, it is appropriate to withhold magnesium sulfate tocolysis from women with recurrent preterm labor thereafter. If magnesium sulfate is given for neuroprotection, a protocol from one of the three major trials that have demonstrated benefits should be used.
Magnesium sulfate tocolysis does not significantly prolong pregnancy or improve perinatal outcomes, but magnesium sulfate administration before anticipated preterm birth appears to have neuroprotective benefits.
1From the Department of Obstetrics & Gynecology, MetroHealth Medical Center, Cleveland, Ohio.
Continuing medical education for this article is available at http://links.lww.com/AOG/A120.
See related editorial on page 500.
The practice of medicine continues to evolve and individual circumstances will vary. This opinion reflects information available at the time of its acceptance for publication, and is neither designed nor intended to establish an exclusive standard of perinatal care. This publication is not expected to reflect the opinions of all members of the Society for Maternal–Fetal Medicine.
Corresponding author: Brian M. Mercer, MD, Professor, Reproductive Biology, Case Western Reserve University, Vice-Chair, Director of Obstetrics & Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, MetroHealth Medical Center, Suite G240, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109.
Financial Disclosure The authors did not report any potential conflicts of interest.