Re: Mg for preeclampsia
From: ainsron (ainsron@sbcglobal.net)
Fri May 18 09:02:07 2007
That was always our philosophy and I think it has served me well over the
years. I haven't had a toxemic patient I've been caring for have a seizure
since residency. Knock on wood!
I wish I could take the credit for remembering all the articles. I did
remember reading that information in Quick Scan Reviews and searched for it
and it was easy to find. I was always impressed by the faculty members in
residency who could quote articles and references on esoteric topics, never
had quite that recall of the literature. That's probably why I didn't go
into academia. TJ on the other hand, appears to have that spontaneous gift.
Ronald E. Ainsworth, MD, FACOG
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E.
Siegel, M.D.
Sent: Thursday, May 17, 2007 6:03 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Mg for preeclampsia
Ron, you are always fast to find a relevant article--the beauty of the
list.
Were you taught, like me:
"If you think Mag, give Mag."
What goes around comes around.
Garry
At Thu, 17 May 2007, ainsron wrote:
>
>I think this review answers your question
>
>Ronald E. Ainsworth, MD
>
>Selective Magnesium Sulfate Prophylaxis for the Prevention of Eclampsia in
>Women With Gestational Hypertension.
>
>Alexander JM, McIntire DD, et al:
>
>Obstet Gynecol; 2006; 108 (October): 826-832
>
>Take-Home Pearl: Since eclampsia is also associated with an increased risk
>of maternal morbidity and neonatal morbidity, one should be cautious about
>the selective use of magnesium sulfate prophylaxis.
>
>Objective: To determine the incidence of eclampsia in patients with severe
>gestational hypertension treated with magnesium sulfate prophylaxis
compared
>to patients with mild gestational hypertension without treatment. Methods:
>This population-based, observational study was performed over a 4.5-year
>period. Patients with severe gestational hypertension received intravenous
>magnesium sulfate prophylaxis and those with nonsevere hypertension
received
>no magnesium sulfate. The criteria for the magnesium sulfate included a
>blood pressure of at least 140/90, 2+ proteinuria or greater, serum
>creatinine >1.2 mg/dL, platelet count of <100,000, elevated liver enzymes,
>and persistent right upper quadrant pain. Both obstetric and neonatal
>outcomes were evaluated with specific attention paid toward the incidence
of
>eclampsia. Results: During this 4.5-year period, 72,004 women were
>delivered. There were 87 patients with eclampsia for an incidence of 1 in
>828; 65,573 patients did not have gestational hypertension. In this group,
>there were 49 cases of eclampsia for an incidence of 1 in 1338. Of these 49
>cases, 32 patients had eclampsia while hospitalized and in 17 had eclampsia
>occur at home. Of 6431 patients with gestational hypertension, there were
38
>cases of eclampsia for an incidence of 1 in 169. In this group with
>gestational hypertension, 3935 women received magnesium sulfate
prophylaxis.
>There were 11 eclamptic seizures in this group for an incidence of 1 in
358.
>A total of 2496 women with nonsevere hypertension did not receive magnesium
>sulfate prophylaxis; 27 had subsequent eclamptic seizures for an incidence
>of 1 in 92. Women with eclampsia were also more likely to have received
>general anesthesia for an emergency cesarean section (23% vs 4%). There
were
>no other differences in morbidity. In 12 patients with eclampsia, there had
>been an increase in blood pressure of the systolic pressure of 30 and of
the
>diastolic pressure of 15 mm Hg; although, the blood pressure was not
>140/90
>mm Hg. Adverse neonatal outcomes were seen more commonly when the mothers
>had eclamptic seizures compared to those with just hypertension without
>eclampsia (12% vs 1%). The incidence of eclampsia during this study period
>was 1 in 828, a 50% increase from the 5 years previous when magnesium
>sulfate was used in all patients with gestational hypertension. Before
>selective administration of magnesium sulfate, the incidence was 1 in 1678
>cases. Conclusions: Selective use of magnesium sulfate prophylaxis is
>associated with an increased incidence of eclampsia secondary to an
increase
>in the frequency of eclamptic seizures with nonsevere gestational
>hypertension not treated with magnesium sulfate. Reviewer's Comments: If
>there is selective administration of magnesium sulfate only in patients
with
>severe hypertensive disease, then the rate of eclampsia will increase.
Since
>eclampsia is also associated with an increased risk of maternal morbidity
>and neonatal morbidity, one should be cautious about the selective use of
>magnesium sulfate prophylaxis. (Reviewer-Thomas N. Tabb, MD
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Andrew
>Folley
>Sent: Thursday, May 17, 2007 5:37 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Mg for preeclampsia
>
>Given 1000 moms with severe toxemia by traditional criteria verses 1000
moms
>
>with mild toxemeia:
>How many in each group will go on to seizure if neither gets mgso4? ie is
>it worth giving mg to moms with mild toxemia? andrew
>
>n_HM_mini_outlook_0507
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
