Quality standard
Quality statement 6: Magnesium sulfate for women between 24+0 and 29+6 weeks of pregnancy
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.
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 can protect the developing fetal brain and so has significant potential to reduce disability.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
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.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service specifications and clinical protocols.
Process
a) Proportion of women between 24+0 and 29+6 weeks of pregnancy in established preterm labour who receive magnesium sulfate.
Numerator – the number in the denominator who receive magnesium sulfate.
Denominator – the number of women between 24+0 and 29+6 weeks of pregnancy in established preterm labour.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
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.
Numerator – the number in the denominator who receive magnesium sulfate 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: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
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.
Healthcare professionals (such as midwives, obstetricians and neonatologists) offer magnesium sulfate 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 or integrated care systems) 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.
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, 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. NICE guideline NG25 (2015, updated 2022), 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]
Magnesium sulfate
Intravenous magnesium sulfate is offered to women in established preterm labour or who are having a planned preterm birth within 24 hours for neuroprotection of the baby. Women having this treatment should be monitored for magnesium toxicity.
In August 2019, this was an off-label use of intravenous magnesium sulfate. See NICE's information on prescribing medicines. Magnesium sulfate is not recommended beyond 24 hours, but if uncertainty around the exact timing of delivery results in repeat administration, follow the Medicines and Healthcare products Regulatory Agency (MHRA) safety advice on the prolonged or repeated use of magnesium sulfate in pregnancy. [Adapted from NICE's guideline on preterm labour and birth, section 1.10]