Re: Intravenously Administered Magnesium Sulfate To Prevent Labor
From: Elrod, Darryl G Maj 48 MDOS/SGOBO (Darryl.elrod@LAKENHEATH.AF.MIL)
Thu Oct 12 03:48:08 2006
We have still used it, but we know full well that when we transfer
patients to the NHS, that it will be turned off as soon as they hit the
door, nearly regardless of gestation.
I can't say that there have been complications from that way either.
Most of what we send as 'preterm labor' gets sent home in a few days
from their care.
Glen
//SIGNED//
D. Glen Elrod, Maj., USAF, MC
Obstetrician/Gynecologist
Chief of Obstetrics
48 MDOS/SGOBO
RAF Lakenheath, England
Telephone DSN: 314-226-8130
Comm: +44 (0) 1638 52 8130
Notice of Confidentiality
Under the Privacy Act of 1974, you must safeguard all information
reflected on this e-mail and, if applicable, all attachments.
Disclosure of information is IAW AFI 33-119, AFI 33-127, AFI 37-131, AFI
37-132, AFI 33-219, and PL 93-579"
This e-mail message including any attachments is for the sole use of the
intended recipient(s) and may contain confidential and privileged
information. Any unauthorized review, use, disclosure or distribution is
prohibited. If you are not the intended recipient, please contact the
sender by reply e-mail and destroy all copies of the original message.
Any questions pertaining to disclosure should be directed to the privacy
officer.
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
Meenan, Anna
Sent: Tuesday, October 10, 2006 8:12 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Intravenously Administered Magnesium Sulfate To Prevent
Labor
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
