Mag Sulfate Antepartum

Jolie, BSN · May 2, 2008

Are her B/Ps stable on oral meds? Does she have any other complaints such as headache, epigastric pain, significant edema, protein in her urine?

If she is stable for 24 hours or so off mag, I don't see why she couldn't go home with frequent office visits to monitor her status.

RNmama05 · May 2, 2008

Mag does not really treat PIH- it keeps patients from seizing though it may lower bp a bit. It may be that she was on the mag prophylactically until serial lab results came back and demonstrated that she was not a worsening pre-eclamptic. If she's not worsening, it wouldn't be unheard of to send her home on bedrest with close monitoring.

drosagain · May 2, 2008

I am not a nurse yet..(I start school Monday! YAY!!) but I have experience in this personally. I was placed on mag because I had BP issues when I was pregnant. I arrived at the hospital with a BP of 177/117 and half of my face was drooping. Needless to say they were concerned it was a stroke, but it ended up being Bells Palsy.

Anyways..they put me on the mag to lower my BP as quickly as possible until I had a dx for the face. (OHHHH What a horrible thing Mag is). Once they dx my face..they did an amnio and determined my little girl was not ready. I was sent home 3 days later with a nurse visiting x3 week. (THough i only made it to the first visit and had to return to the hospital).

I got into an argument with my resident about the fact that I was placed on the Mag for my bp..and she said no that it was not used to lower BP...blah blah. Once my doctor came to check on me, I asked her and she said that in fact they did do it to treat the BP and not to worry about.

So to answer your question, yes they can be sent home....and yes in fact some doctors use mag to treat BP.

My BP was a factor for the last trimester and i had no signs of PE at all during this time.

Jolie, BSN · May 2, 2008

I got into an argument with my resident about the fact that I was placed on the Mag for my bp..and she said no that it was not used to lower BP...blah blah. Once my doctor came to check on me, I asked her and she said that in fact they did do it to treat the BP and not to worry about.
So to answer your question, yes they can be sent home....and yes in fact some doctors use mag to treat BP.

It's a bit of an oversimplification to state that MgSO4 is used to treat B/P in PIH.

The following is from e-medicine: http://www.emedicine.com/EMERG/topic480_3.htm

Control of seizures

Active seizures should be treated with intravenous magnesium sulfate as a first-line agent.

Prophylactic treatment with magnesium sulfate is indicated for all patients with severe preeclampsia.

For seizure refractory to magnesium sulfate therapy, benzodiazepines and/or phenytoin may be considered.

Medication Magnesium sulfate is the first-line treatment for prevention of primary and recurrent eclamptic seizures. For eclamptic seizures refractory to magnesium sulfate, lorazepam and phenytoin may be used as second-line agents.

Magnesium sulfate -- First-line therapy for seizure prophylaxis. Antagonizes calcium channels of smooth muscle. Indicated in severe preeclampsia, eclampsia, and preeclampsia in the near term. Administer IV/IM for seizure prophylaxis in preeclampsia. Use IV for quicker onset of action in true eclampsia.

Hydralazine (Apresoline) -- First-line therapy against preeclamptic hypertension. Decreases systemic resistance through direct vasodilation of arterioles, resulting in reflex tachycardia. Reflex tachycardia and resultant increased cardiac output helps reverse uteroplacental insufficiency, a key concern when treating hypertension in a patient with preeclampsia. Adverse effects to the fetus are uncommon.

GilaRRT · May 2, 2008

I have to agree. Magnesium sulfate is not typically considered an antihypertensive agent. Magnesium works to antagonize calcium at the neuromuscular junction. This prevents the release of acetylcholine and nervous communication to the muscle. This is how it woks to prevent seizures.

A transient drop in blood pressure can occur most likely resulting from smooth muscle relaxation; however, blood pressure changes can be quite unpredictable. I would think the prudent provider would want to avoid using magnesium sulfate as the sole agent in blood pressure control.

DoubleblessedRN, ADN, RN, EMT-B, EMT-P · May 11, 2008

Is it possible that a pt might be discharged on Procardia? I know that is one drug that treats PIH. I'm only a nursing student and I only know the very basics of OB.

I was hospitalized at 30 weeks for preterm labor, but not full blown. I was on a MgSO4 drip for a little over 24 hours, was given IM Decadron, and once the Mg was d/c'd I was given Procardia and discharged the next day.

I know MgSO4 is given when Procardia or other drugs fail to control the BP, but can it be resumed after Mg?

Jolie, BSN · May 12, 2008

Procardia is often used as a treatment for PTL. It is a smooth muscle relaxer and can lessen or stop uterine contractions.

MgSO4 is also a smooth muscle relaxer, and is one of the most effective drugs available for the emergency treatment of PTL. When a patient comes in contracting regularly and demonstrates cervical changes, MgSO4 may be the drug of choice. However as you probably remember, it is a miserable drug, with many uncomfortable side-effects, and some potentially dangerous ones. So most docs try to wean the patient off of it as soon as possible, usually within 24-48 hours. At that time, an oral drug such as Procardia may be tried, in preparation for discharging the patient home. In this case, neither the MgSO4 nor the Procardia are used for treatment of B/P, but treatment of PTL.

The IM decadron was given to hasten your baby's lung and other organ development in the case of pre-term delivery.

Hope all went well!

DoubleblessedRN, ADN, RN, EMT-B, EMT-P · May 12, 2008

Thanks Jolie. I understood why I was on the Procardia at that time. The MgSO4 displaces the Ca+ which has a major effect on smooth muscle, and the Procardia is a Calcium Channel Blocker and sort of does the same but is not as potent. I was wondering if they might do that for PIH as well.

By the way, is using Procardia as a tocolytic pretty much a standard, but not necessarily a first line for PTL?

During a post conference in my OB clinical, we were looking at a list of the commonly used drugs for OB and discussing some of them. I saw the Procardia and mentioned that I had that for PTL. My instructor gave me a funny look and said, "Oh no no no. It wasn't for that. You had pregnancy induced hypertension," in a very condescending tone. I didn't answer back, but I was astonished that an instructor who had worked OB for all or most of her 40+yr nursing career didn't know a seemingly common knowledge treatment for PTL. (Among OB nurses) I don't think many non-OB nurses know that because it wasn't in a few recent nursing drug books, nor in my pharmacology textbook in the OB chapter, but there IS one sentence about it in my OB textbook which was published in 2006. I never checked the PDR, though.

Jolie, BSN · May 12, 2008

I've not seen it used to lower B/P in PIH, but that doesn't mean it's not done.

Nor have I seen Procardia used as a first-line treatment for PTL. I don't believe that it is as effective in stopping contractions as MgSO4 or terbutaline, but it does seem to have a decent effect in keeping the uterus "quiet" once that state is achieved with other, more powerful tocolytics.

Yes, your instructor made herself look silly by insisting that Procardia is used only for PIH. I realize that practices vary somewhat from one area to another, so not all OBs use it for PTL, but anyone who keeps up with journal articles should be aware. I doubt you will find much information in the drug books, though, since it is an off-label use.