Re: Intravenously Administered Magnesium Sulfate To Prevent Labor
From: art fougner, md (evsono@pipeline.com)
Thu Oct 12 06:53:58 2006
All this begs the question concerning the efficacy of tocolysis in
general ...
Art
At Thu, 12 Oct 2006, Elrod, Darryl G Maj 48 MDOS/SGOBO wrote:
>
>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
>
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>-----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
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
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