## Fetal Neuroprotection in Preterm Abruption **Key Point:** Magnesium sulphate is the drug of choice for neuroprotection when delivery is anticipated before 32 weeks in placental abruption, regardless of whether labour is present. **High-Yield:** The MAGENTA trial and WHO guidelines recommend magnesium sulphate for all women at risk of preterm delivery (< 32 weeks) to reduce cerebral palsy and gross motor dysfunction by ~30%. ### Mechanism of Neuroprotection - Stabilizes neuronal cell membranes - Reduces excitotoxicity from glutamate - Anti-inflammatory effects on developing brain - Most effective when given before delivery ### Dosing in Abruption - **Loading dose:** 4 g IV over 20–30 minutes - **Maintenance:** 1 g/hour IV until delivery or for 12 hours - Administer as soon as preterm delivery is anticipated **Clinical Pearl:** In this case, the patient is at 28 weeks with significant abruption — magnesium sulphate is indicated for neuroprotection even if the abruption is managed conservatively initially. ### Comparison with Other Agents | Agent | Indication in Abruption | Role | |-------|------------------------|------| | Magnesium sulphate | Preterm delivery < 32 weeks | Neuroprotection (first-line) | | Betamethasone | Preterm delivery 24–34 weeks | Fetal lung maturity (adjunct) | | Nifedipine | Hypertension/tocolysis | Not for neuroprotection | | Labetalol | Hypertension control | Not for neuroprotection | **Warning:** Do not confuse neuroprotection (magnesium sulphate) with tocolysis (nifedipine, terbutaline). In abruption, tocolysis is often avoided due to risk of masking deterioration. [cite:FIGO Guidelines on Placental Abruption 2018; WHO Recommendations on Interventions to Improve Preterm Birth Outcomes]
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