Literature
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Fri May 18 20:09:53 2007
Ron:
Don't sell yourself short; you are pretty darn smart.
I had one MFM faculty who was awfully smart and could even link basic
science (things like biochemistry) to clincal practice.
Garry
At Fri, 18 May 2007, ainsron wrote:
>
>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
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
