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Re: Terbutaline, MgSO4 From: Luis Sanchez-Ramos (sanchez-ramos@worldnet.att.net) Tue Dec 30 19:07:04 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Cathy Harsha MD: "Re: Prenatal Rituals" Previous message: Larry glazerman: "Re: OB:Prenatal Rituals" In reply to: Richard Lowensohn: "Re: Terbutaline, MgSO4" At Tue, 30 Dec 1997, Richard Lowensohn wrote: > >Dr. Sanchez-Ramos - > >1) Since the number of trials on efficacy is small, it makes little >sense to dismiss the possibility that it might work. Safety was >(heretofor) based on the ample years of experience in >pre-eclampsia. The University of Chicago study is the first to >suggest that there may be other concerns in premature fetuses. > >2) The pharmacologic principle is that the only way to use a drug is to >use it to effect and/or a specific target blood level. In this case, the >data show that it takes a lot in to get to a good blood level, since the >kidneys do such a good job of taking it back out. Most of our patients >maintain stable levels (long-term) on 2 or even 2 1/2 grams/hour, so >it makes sense that it would take more to raise it. > Dr. Lowensohn: > >I haven't dismissed the possibility that any given tocolytic may be effective in a subgroup of patients with preterm labor. Taking them individually and as a group, they have not shown great efficacy. It is true that for many of these studies a type II error may exist, but that is what the data show at this moment. One important reason for the lack of signficant benefit is the multifactorial nature of PTL. I doubt we will find a single agent that will supress PTL in a majority of patients. We of course use tocolytics just like everyone else. But I am not convinced that they really afford much benefit. As for the Chicago study, I would like more information on the Material and Methods. Did they obtain follow up on all infants and for how long ? Many of the deaths ocurred several weeks after birth and were due to causes hard to associate with magnesium ie, twin-to-twin transfusion, congential anomalies etc. I am sure more studies on this subject will soon be underway. Are you aware of a RCT in which serum magnesium levels have shown improved efficacy ? -- Luis Sanchez-Ramos, M.D. University of Florida Next message: Cathy Harsha MD: "Re: Prenatal Rituals" Previous message: Larry glazerman: "Re: OB:Prenatal Rituals" In reply to: Richard Lowensohn: "Re: Terbutaline, MgSO4"

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