Quality statement 6: Magnesium sulfate for women between 24+0 and 29+6 weeks of pregnancy

Quality statement

Women between 24+0 and 29+6 weeks of pregnancy who are in established preterm labour or having a planned preterm birth within 24 hours are offered magnesium sulfate[5].

Rationale

With advances in neonatal care in recent years, more babies born preterm are surviving. These children frequently have long-term complications associated with preterm birth. Neurological effects are common and may cause severe disability. Magnesium sulfate[5] can protect the developing fetal brain and so has significant potential to reduce disability.

Quality measures

Structure

Evidence of local arrangements and written clinical protocols to ensure that women between 24+0 and 29+6 weeks of pregnancy who are in established preterm labour or having a planned preterm birth within 24 hours are offered magnesium sulfate[5].

Data source: Local data collection.

Process

a) Proportion of women between 24+0 and 29+6 weeks of pregnancy in established preterm labour who receive magnesium sulfate[5].

Numerator – the number in the denominator who receive magnesium sulfate[5].

Denominator – the number of women between 24+0 and 29+6 weeks of pregnancy in established preterm labour.

Data source: Local data collection.

b) Proportion of women between 24+0 and 29+6 weeks of pregnancy who are having a planned preterm birth within 24 hours who receive magnesium sulfate[5].

Numerator – the number in the denominator who receive magnesium sulfate[5] in the 24 hours before the birth.

Denominator – the number of women between 24+0 and 29+6 weeks of pregnancy who have a planned preterm birth.

Data source: Local data collection.

Outcome

Incidence of cerebral palsy.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (such as secondary or tertiary care services) ensure that women between 24+0 and 29+6 weeks of pregnancy who are in established preterm labour or having a planned preterm birth within 24 hours are offered magnesium sulfate[5].

Healthcare professionals (such as midwives, obstetricians and neonatologists) offer magnesium sulfate[5] to women between 24+0 and 29+6 weeks of pregnancy who are in established preterm labour or having a planned preterm birth within 24 hours.

Commissioners (clinical commissioning groups) commission services that ensure that women between 24+0 and 29+6 weeks of pregnancy who are in established preterm labour or having a planned preterm birth within 24 hours are offered magnesium sulfate[5].

Women who are more than 24 weeks but less than 30 weeks pregnant and in established preterm labour, or having a planned preterm birth within 24 hours, are offered magnesium sulfate[5], as this medicine is likely to help their baby. The benefits and risks of this treatment are explained to them.

Source guidance

Preterm labour and birth (2015, updated 2019) NICE guideline NG25, recommendation 1.10.2

Definitions of terms used in this quality statement

Established preterm labour

A woman is in established preterm labour if she has progressive cervical dilatation from 4 cm with regular contractions.

[NICE's guideline on preterm labour and birth, terms used in this guideline]

Planned preterm birth

A planned birth before 37+0 weeks of pregnancy because of medical complications.

[NICE's full guideline on preterm labour and birth, glossary]



[5] Although this use is common in UK clinical practice, at the time of publication (August 2019), magnesium sulfate did not have a UK marketing authorisation for this indication. The prescriber should see the summary of product characteristics for the manufacturer's advice on use in pregnancy. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Council's Prescribing guidance: prescribing unlicensed medicines for further information.