FACTORS ASSOCIATED WITH PHARMACOLOGIC SERUM CONCENTRATION OF MAGNESIUM AND CORRESPONDING OBSTETRIC OUTCOMES AMONG WOMEN WITH SEVERE PRE-ECLAMPSIA AT IRINGA REGIONAL REFERRAL HOSPITAL

Abstract

Severe pre-eclampsia is managed by using Magnesium sulphate to prevent its progress into eclampsia with a success rate of more than 50%. This study aimed at establishing reliable data pertaining factors influencing pharmacologic serum concentration of Magnesium and their correlation to obstetric outcomes. This study was carried out at Iringa regional referral hospital, spanning six months from November 2023 to April 2024. A convenient sampling technique was used to recruit 121 pre-eclamptic patients. Recruited women were tested serum Magnesium at admission, 4 and 12 hours post initial administration of MgSO4. IBM SPSS version 29 was used for analysis where, Continuous variables were analyzed by using median and interquartile range while categorical variables were analyzed using frequency and percentages. The associations between variables were determined using chi-square tests, univariate, and multivariate binary regression models. A p value<0.05 was considered statistically significant. Results: The median age of participants were (29±10 IQR), the median serum Mg at admission was (0.8±0.29 IQR) Mmol/L majority with low 53(43.8%) levels. Proportion of subtherapeutic serum Mg was 38.8% with median of (1.9±1.02 IQR) Mmol/L. Multivariate regression showed that; low serum Mg at admission [p<0.001, OR= 9.17, 95% CI (3.07- 27.37)], Creatinine level [p = 0.012, OR= 4.49, 95% CI (1.38- 14.6)], Overweight [p= 0.002, OR= 5.52, 95% CI (1.83- 16.68)] and proteinuria +++[p-value = 0.004, OR= 7.13, 95% CI (1.84- 26.86)] were significantly associated with subtherapeutic level. After adjusting with other factors, it was found that subtherapeutic level [p<0.001, OR=25.44(5.73-112.90)], elevated creatinine [p=0.040, OR=3.59(1.66-12.15)], Reduced urine output [p=0.001, OR=6.69(2.15-20.90)] were significant predictors of adverse maternal outcomes. Conclusion: Subtherapeutic serum Magnesium which significantly predict adverse obstetric outcomes, is influenced by factors which can be monitored and be useful in effective management of severe pre-eclampsia. This can help in administering tailored dose of MgSO4 for better outcomes.