Preterm labor is defined as labor that starts before 37 weeks of pregnancy. It occurs when the uterus contracts regularly and leads to changes in the cervix. Ten percent of women in preterm labor give birth within the next seven days. But for the majority of women, preterm labor stops on its own.
In the United States, magnesium sulfate has become the most commonly used drug for treating preterm labor. Magnesium sulfate is given only intravenously. A woman is given an initial infusion of 4 to 6 grams over 15 to 30 minutes, and then a maintenance dose of 2 to 3 grams per hour.
Doctors do not know exactly how magnesium sulfate inhibits contractions. The most common explanation is that magnesium lowers calcium levels in uterine muscle cells. Since calcium is necessary for muscle cells to contract, this is thought to relax the uterine muscle.
Magnesium sulfate is often quite effective in slowing contractions, although this effect and how long it lasts varies from woman to woman. Like all tocolytic medications, however, magnesium sulfate does not consistently prevent or delay preterm delivery for a significant period of time.
Even so, studies have shown that magnesium sulfate can delay delivery for at least several days (depending on how far dilated a woman's cervix is when the medication is started).
This isn't a lot of time, but it can make a big difference for the fetus if the mother is given steroids along with magnesium sulfate. After 48 hours, steroids improve a baby's lung function and reduce the risk of dying by 40 percent.
Magnesium sulfate also reduces the infant’s risk for cerebral palsy if they are born too early.
For the Mother
About half of the women who receive magnesium sulfate have some side effects. Potential side effects include flushing, feeling uncomfortably warm, headache, dry mouth, nausea, and blurred vision. Women often say they feel wiped out, as though they have the flu. These side effects can be uncomfortable, but they are not dangerous.
When given in high doses, magnesium sulfate can cause cardiac arrest and respiratory failure. Fortunately, women can be monitored for increases in the magnesium blood levels. If the levels become too high, the dose can be lowered.
One of the most common signs that nurses watch for is the loss of the knee-jerk reflex (a jerk that usually occurs when your leg is tapped just below the knee). Your urine output will also probably be measured every hour in the hospital to avoid toxicity.
If for some reason the levels get too high, another medication, called calcium gluconate, can help reverse the effects of magnesium sulfate.
For the Baby
Since magnesium sulfate relaxes most muscles, babies who have been exposed to magnesium for an extended period of time may be listless or floppy at birth. This effect typically goes away as the drug clears from the baby's system.
Women with medical conditions that could be made worse by the side effects described above should not be given magnesium sulfate or similar drugs. This includes women with myasthenia gravis (a muscle disorder) or muscular dystrophy.
Some women may be at a higher risk for a preterm birth. Factors include:
- previous preterm birth
- short cervix
- short time between pregnancies
- history of surgery on uterus/cervix
- pregnancy complications
- lifestyle factors (such as smoking during pregnancy, low prepregnancy weight, substance abuse)
Talk to your doctor if you are concerned you may be at risk. You may need to take certain precautions during pregnancy like bed rest so you don’t go into labor too early.
If you suspect you’re going into early labor and haven’t reached 37 weeks of pregnancy, call your doctor. They will be able to determine the next steps, including if you need to be monitored and/or evaluated.