Dane A De Silva1, Diane Sawchuck2, Peter von Dadelszen1, Melanie Basso3, Anne R Synnes4, Robert M Liston2, Laura A Magee5. 1. Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute, University of British Columbia, Vancouver BC. 2. Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC. 3. Children's and Women's Health Centre of British Columbia, Vancouver BC. 4. Child and Family Research Institute, University of British Columbia, Vancouver BC; Department of Pediatrics, University of British Columbia, Vancouver BC. 5. 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.
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. CONCLUSION: 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.
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. CONCLUSION: 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: Dane A De Silva; Lily Proctor; Peter von Dadelszen; Meghan McCoach; Tang Lee; Laura A Magee Journal: PLoS One Date: 2017-12-22 Impact factor: 3.240
Authors: Dane A De Silva; Anne R Synnes; Peter von Dadelszen; Tang Lee; Jeffrey N Bone; Laura A Magee Journal: Implement Sci Date: 2018-01-11 Impact factor: 7.327