Re: Intravenously Administered Magnesium Sulfate To Prevent Labor
From: Cesar Molina (cemolar777@gmail.com)
Tue Oct 10 22:27:58 2006
It is the same in my institution. I would like a copy of this article.
Thanks.
2006/10/10, Meenan, Anna <annam@uic.edu>:
>
> 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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