[SC RN]

I have a patient on L&D (antepartum) who has been on complete bedrest for PTL for 30 days now. The doses of Magnesium Sulfate that we have to give her to stay out of labor are so large that she is constantly sick and miserable and she is now ready to give up. She feels that she just can't stay pregnant any longer or she'll lose her mind (hx of depression, first child at 29 wks - now healthy). An ultrasound first showed the AFI of Baby A to be 3 so she was going to be having a c/sec but a subsequent u/s showed the AFI to be 7.4 so she is in a waiting game yet again.

She is now 31 4/7 wks pregnant with twins. I have searched all over the internet looking for something to give her that states a day by day benefit of keeping them in their longer. Does anyone now of such a thing? I'd love to be able to visually show her the benefits to the lungs, the GI tract, the Brain, etc, etc. I'm hoping you wise NICU nurses can help me ... I really want to help her "want" to stay pregnant ... altho I can't say that I know how miserable it is to be on MGSo4 for this long of a time! Thanks for your help!

[Deidre Shiobhan]

In my unit all high risk pregnancies or prem labours will be in the high risk consult gp meaning these patients will be managed by their individual O&G doctors and also the neonatologist. These parents will be counselled and spoken to by our neonatologist should they go into prem labour and are inhibiting in L&D room, they will be told of the mortality and morbity rate and the expected outcome should they delivered thus allowing them to consider and prepare themselves expecially the extreme prem such as 23weekers.

[Jolie]

Originally Posted by SC RN

I have a patient on L&D (antepartum) who has been on complete bedrest for PTL for 30 days now. The doses of Magnesium Sulfate that we have to give her to stay out of labor are so large that she is constantly sick and miserable and she is now ready to give up. She feels that she just can't stay pregnant any longer or she'll lose her mind (hx of depression, first child at 29 wks - now healthy). An ultrasound first showed the AFI of Baby A to be 3 so she was going to be having a c/sec but a subsequent u/s showed the AFI to be 7.4 so she is in a waiting game yet again.

She is now 31 4/7 wks pregnant with twins. I have searched all over the internet looking for something to give her that states a day by day benefit of keeping them in their longer. Does anyone now of such a thing? I'd love to be able to visually show her the benefits to the lungs, the GI tract, the Brain, etc, etc. I'm hoping you wise NICU nurses can help me ... I really want to help her "want" to stay pregnant ... altho I can't say that I know how miserable it is to be on MGSo4 for this long of a time! Thanks for your help!

Boy, do I feel for that woman! I had 2 high risk pregnancies with very resistant pre-term labor. Every time I was admitted, I required a loading dose of 6-8 grams of MgSO4, followed by 4-6 grams per hour for at least 48 hours. By the third or fourth admission, I was ready to give up due to feeling so miserably sick myself, but as a NICU nurse, I knew the harm that could cause my still very premature babies. I had a long discussion with my primary nurse and physician regarding what measures could be taken to lessen the ill effects of the Mag therapy, and how to make my admission(s) more tolerable so that I would be willing to continue with the only medication that was effective in bringing my contractions under control.

We agreed to a private room, consistent group of nurses, sedation and anti-nausea medications, limited monitoring, less frequent vitals, reflex checks and blood draws (once a stable level had been achieved) so that I could actually get some rest, family to provide appetizing food from home, etc.

While nothing can possibly make Mag therapy pleasant, these things went a long way toward making it bearable. Perhaps you could approach your patient and her OB/CNM with some of these suggestions.

Please give her my best, from someone who has been there, and now has 2 healthy girls to show for it!

[SC RN]

Thanks so much for the input ... your reply gave me valuable ideas that I will present to both the MD and the patient tomorrow. I've spent all weekend thinking about her and wondering how we can help her get through as far as possible. I'm going to start simple and go from there and hope that we can get her healthy twins a few weeks down the road!

[Jolie]

Thanks for going to bat for her!

Had it not been for a great group of nurses and 1 particular doc in my OB group, I probably would have lost my mind. My favorite doc had experienced pre-term labor and bedrest herself, and was particularly sympathetic to the "little things". Her day to make rounds was Wednesday. I always knew that I would get a shower on Wednesday. She would write for a hep lock and shower every week, and her partners would come in on Thursday and resume complete bed rest. Ah, for one day of freedom!

[wannabeL&D73]

Mag is truly horrible stuff. But honestly, as bad as it is, it is still a million times better than preemie twins in the NICU, more drs. visits when they finally get home (for synagis etc.), worry about their health, and guilt for not sticking it out longer. Does she have a laptop? If there is anyway her family or friends could somehow get her one there are great support groups on line at Babycenter, parentsplace, and also sidelines.org. I checked this site everyday...don't know how accurate it is, but I found it very encouraging and clearly showed the benefits of every day keeping baby in...oops, just went to look up the chart, and it only goes to 30 weeks.

Anyway, I know from personal experience that hospitalized bedrest is incredibly difficult...but I really don't care how bad the mag is...I prayed for every additional day of pg., and those babies deserve as much time as they can possibly get in the womb.

Shannon