Question 28

A 25 yo female at 28 weeks of gestation presents with contractions every 3 minutes. Her cervix is 4 cm dilated and 50% effaced. A category I tracing is noted. Ferning is negative. Antenatal corticosteroids are given for fetal maturation. GBS was negative last week. The best medication to lower the risk of cerebral palsy in her infant is:

Answer Choices:

Azithromycin

Indomethacin

Magnesium sulfate

Nifedipine

Penicillin

Correct Answer:

Magnesium sulfate

Explanation:

  • Cerebral palsy is a neurologic condition with a spectrum of motor, cognitive and sensory impairments

  • The prevalence of CP is 2 per 1000 births which increases at earlier gestational ages (82 per 1000 in births prior to 28 weeks)

  • Magnesium was originally used as a tocolytic (to stop contractions), but it is ineffective for that purpose

  • Several RCTs have shown that magnesium may function as a neuroprotectant to decrease the risk of cerebral palsy by up to 32% in preterm infants

  • ACOG and SMFM recommend magnesium be given to patients less than 32 weeks