Re: Intravenously Administered Magnesium Sulfate To Prevent Labor
From: Meenan, Anna (annam@uic.edu)
Tue Oct 10 14:11:31 2006
Interesting. We use a lot of Mag in this neck of the woods. I have
to make a tiny complaint about the fact that, while technically true,
the statement about infusing epsom salts intravenously may be just
the teensiest bit irresponsible on the part of a lay publication.
Conjures up images of injecting IV the stuff that people soak their
feet in. Could you send me a copy of the Green Journal article?
Would love to get a discussion going with the residents.
Anna Meenan, MD
>.
>
>Intravenously Administered Magnesium Sulfate To Prevent Labor Ineffective,
>Potentially Deadly, Commentary Says
>
>Access this story and related links online:
>http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=40292
>
>Magnesium sulfate administered intravenously to a pregnant woman who
>is about to
>deliver a premature infant is an unconfirmed, ineffective and
>potentially fatal
>treatment, David Grimes and Kavita Nanda of Family Health International write
>in an Obstetrics and Gynecology commentary published in the October issue of
>the journal, the Washington Post reports. Infusions of magnesium sulfate, or
>Epsom salts, commonly are administered to pregnant women between 26 and 34
>weeks' gestation for about 48 hours to delay contractions and allow the
>injection of steroids, which increases the rate of fetal lung development.
>According to the Post, magnesium sulfate can cause side effects that include
>blurred vision, burning sensations, headaches, nausea and "profound lethargy."
>In some cases, it can lead to pulmonary edema, a condition in which the lungs
>fill with liquid, the Post reports. The commentary is a response to a study
>conducted by the Cochrane Collaboration that reviewed 23 clinical trials
>conducted worldwide involving 2,000 pregnant women who had received the drug.
>The study finds that the use of magnesium sulfate did not reduce preterm labor
>and that more infants died as a result of administering drug compared with the
>control group. Grimes and Nanda estimate that about 120,000 U.S. women receive
>magnesium sulfate annually and that its use might be associated with 1,900 to
>4,800 fetal deaths annually in the country. According to Grimes, physicians
>seeking to delay premature contractions that can prompt labor should use a
>calcium channel blocker such as nifedipine, which has been proven effective.
>
>Comments
>
>The use of magnesium sulfate is a "North American anomaly" that is
>predicated on
>"good hopes and good wishes rather than good data," Grimes said. For many
>physicians, "there is pressure to use [magnesium sulfate] from patients, as
>well as peer pressure" from other doctors, Gary Cunningham, a professor at the
>University of Texas Southwestern Medical Center, said. He added that the drug
>has a "powerful constituency" and is an effective treatment for other
>conditions -- such as preeclampsia, eclampsia or pregnancy-induced
>hypertension. Michael Gallagher, a maternal and fetal medicine specialist at
>Shady Grove Adventist and Holy Cross hospitals, said, "There is current
>practice (to use the drug) that is the community standard." He added that use
>of magnesium sulfate is a safe and viable option in some cases and is not an
>ineffective and dangerous drug (Boodman, Washington Post, 10/10).
>
>--
>
>Additional Comments by Dean Huffman
>
>1) When I was in practice in Kansas as an MFM, I had a patient
>transferred to me
>from Fort Riley. She was 34 weeks, in labor. She had received MgSO4,
>Terbutaline, and ritrodrine (the only drug ever approved by the FDA for
>labeling as a tocolytic -- no longer on the market) and about 10 liters of
>saline, all IV. I heard about her only when she was in the air. On
>arrival, she
>was in fulminant pulmonary edema. I immediately intubated her, got a pulmonary
>consultation, and stopped all tocolytics. She delivered a few hours later. The
>baby did fine -- needed only a little O2 by mask. The mother died about a week
>later from ARDS.
>
>2) Grimes was one of my examiners for the oral MFM boards.
>
>3) If anybody wants a copy of the article from the Green Journal and does not
>otherwise have access, contact me privately (dean@thehuffpeople.net)
>
>Dean Huffman
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