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Master Thesis

Évaluation du protocole d'administration du sulfate de magnésium à visée neuro-protectrice fœtale au sein d'une maternité de niveau III

Abstract : Background: magnesium sulfate, a neuroprotective agent, has recently demonstrated its potential in reducing the risk of cerebral palsy in preterm infants. The National College of French Gynecologists and Obstetricians (CNGOF) published Clinical Practice Guidelines (CPG) in 2016 regarding its application. In the matter of the valuable results obtained with magnesium sulfate, the implementation of these recommendations within French maternities evidently seems inevitable. Objective: to assess the implementation of an antenatal magnesium sulfate protocol for fetal neuroprotection within the maternity of Port-Royal, a tertiary obstetric center. Materials and methods: this quantitative retrospective single-center study included all women who delivered between 23 weeks of gestation and 28+6 weeks of gestation from July 1, 2018 to December 31, 2019 within Port-Royal. Non-inclusion criteria were stillbirth, medical abortion and palliative care project for newborn. The primary outcome was the magnesium sulfate prescription rate as well as the evolution of the prescription rate throughout our study. The second outcomes were the evolution of the prescription rate throughout our study, the factors leading to forgetfulness, maternal side effects and the maternal monitoring during the administration. Results: data from 196 women were analyzed. Three years after the implementation of the protocol within Port-Royal, 94.6% of the women without contraindication received magnesium sulfate before preterm delivery. A significative evolution of the prescription rate has been observed along the study, rising from 91.3% to 98.7% (p=0.042). Suboptimal clinical surveillance was significatively augmented during the weekend (p=0.021), when the administration duration was less than 2 hours (p=0.010) or when the childbirth occurs via C-section (p<0.01). We observed 15 interruptions of administration after maternal side effects apparition (9.4%) but no severe adverse effects were noted. Conclusion: our study shown that the application of the magnesium sulfate protocol for neuroprotection fetal was thoroughly implemented within Port-Royal. Nevertheless, improvements are still required concerning the monitoring of its administration. Physicians awareness raising regarding this issue should be considered. However, in light of the reassuring results we obtained, the expansion of the protocol to 32 weeks of gestation, as per the recommendations of CNGOF seems henceforth feasible.
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https://dumas.ccsd.cnrs.fr/dumas-03055943
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Submitted on : Friday, December 11, 2020 - 3:33:42 PM
Last modification on : Wednesday, June 2, 2021 - 4:26:07 PM
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Laurine Gaspard. Évaluation du protocole d'administration du sulfate de magnésium à visée neuro-protectrice fœtale au sein d'une maternité de niveau III. Gynécologie et obstétrique. 2020. ⟨dumas-03055943⟩

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