Administration patterns of magnesium sulphate for women with preeclampsia and immediate newborn outcomes in Kawempe National Referral Hospital

Abstract

Background: Pre-eclampsia is one of the leading causes of maternal and perinatal mortality and morbidity worldwide. In Uganda, the MOH adopted the WHO recommendation of using MgSO4 to prevent and treat pre-eclampsia with severe features (SPE) and eclampsia among expectant mothers. Previous research has highlighted discrepancies in MgSO4 administration patterns. Aim: To describe MgSO4 administration patterns in women with SPE or eclampsia and the immediate newborn outcomes of neonates exposed to intrapartum MgSO4 at Kawempe National Referral Hospital. Methodology: Analytical cohort study design was employed to collect data from pregnant women at 28 weeks of gestation diagnosed with SPE or eclampsia and being treated with intrapartum magnesium. 207 respondents were targeted at power 80 and 95% confidence. Structured interviews, observations, and document reviews were used to collect data from August to October 2022 from 210 respondents, which was analyzed using SPSS 23. Descriptive statistics were run to report frequencies, means and standard deviations. In addition, bivariate and multivariate logistic regression models were conducted to determine factors associated with the low Apgar score at five minutes. Results: All mothers received MgSO4 loading dose, 181/210 (86.2%), 152/210 (72.4%), 131/210 (62.4%), 112/210 (53.3%), 95/210 (45.2%) and 70/210 (33.3%) received the first, second, third, fourth fifth and sixth maintenance doses respectively. Only 70/210 (33.3%) completed the full dose of MgSO4 that is loading and six maintenance doses. The majority, 178/210 (84.8%), of the mothers delivered live babies, while 32/210 (15.2%) delivered stillbirths (13/32; 40.6% FSBs and 19/32; 59.4% MSBs). 65/210 (31.0%) NICU admissions were done mostly due to; respiratory distress 45/65 (21.4%) and preterm delivery 44/65 (21.0%). Thompson scores were done on 54/65 (83.1%) NICU admissions, 38/54(70.4%) had a score of 1 to 10, 16/54 (29.6%) had a normal score, and 11/65 (5.5%) of the NICU admissions died within seven days of admission. After adjusting for confounders, there was an increased likelihood of newborns having low Apgar scores at five minutes in mothers aged below 25 years (AOR=3.23, CI: 0.29-35.44) and those that were labour induced (AOR=2.08, CI: 0.18-22.89. In addition, 4-hourly timing of the first maintenance dose decreased the likelihood of having low Apgar scores at five minutes among newborns of mothers receiving intrapartum MgSO4. Conclusion: Drug administration patterns in the study were not congruent with the international and local recommendations. NICU admissions and stillbirths were common among neonates exposed to partial intrapartum MgSO4 doses. Respiratory distress and preterm delivery are the leading cause of NICU admissions in newborns exposed to in-utero MgSO4. A complete dose of MgSO4 sulphate decreases the likelihood of low Apgar score at 5 minutes in newborns. Reccomendations: Facilities should adhere to MgSO4 administration guidelines in addition to adopting the use of labour monitoring tools to improve newborn outcomes.