Meds used to stop preterm labour

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i was recently sent an article that states the use of magnesium sulfate to women in preterm labour may be dangerous...i have posted a portion of the article...

"magnesium sulfate administered intravenously to a pregnant woman who is about to deliver a premature infant is an unconfirmed, ineffective and potentially fatal treatment, david grimes and kavita nanda of family health international write in an obstetrics and gynecology commentary published in the october issue of the journal, the washington post reports. infusions of magnesium sulfate, or epsom salts, commonly are administered to pregnant women between 26 and 34 weeks' gestation for about 48 hours to delay contractions and allow the injection of steroids, which increases the rate of fetal lung development. according to the post, magnesium sulfate can cause side effects that include blurred vision, burning sensations, headaches, nausea and "profound lethargy." in some cases, it can lead to pulmonary edema, a condition in which the lungs fill with liquid, the post reports." (from medical news today)

the article then goes on to discuss the use of mgso4 seems to be only in north america and is not commonly practiced in other parts of the world.

at my hospital we do not use mgso4 to stop preterm labour on most cases and instead use a nitro patch, which is just as effective and with less side effects.

what's the protocol at your hospital?

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yikes! a nitro patch. i had nitro for r/o mi and had such an awful headache that i vowed never to take it again. are we talking about the same nitro???

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We use Terbutaline 0.25mg SQ as close to 20 minutes btwn doses and up to several doses. We sometimes have pts take po terbutaline, usually 5mg q 4 hours or procardia (niphedapine) po. We have also had pts on terbutaline pumps, same concept at insulin pumps. Also use fluid boluses, check UA, etc... We do use MgSO4, and it can have all of the side effects listed in your post, but pts on mag are so closely monitored for those sx that they really start to hate us for bugging them all the time.

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We use gallons of mag at my facility. Many of our patients stay on mag for weeks, months even. We push the envelope by giving IV mag and brethine SQ or PO (or ventolin) together also. I understand most places don't do that because of the increased risk of pulmonary edema, but I don't understand magging a pt for 2-3 days for the steroid window and then allowing delivery if deliver can be stalled for much longer.

I have been told by others (not coworkers) that we may overtreat PTL. Perhaps. I have seem pts come off mag and go home (less commonly) and I have seen pts come off mag and go right into labor (more commonly). I guess it would be nice to be able to predict which way each pt will go, but that can't be done. Why deliver a 26 weeker when you could deliver a 36 weeker?

Is mag a dangerous drug? Certainly. That doesn't worry me- nurses give many dangerous drugs. Some studies indicate that mag reduces the incidence of brain bleeds in preemies, too. That's certainly a useful benefit.

We also use procardia and indocin some, but not very much.

We also do mag washes to reset brethine requirements for pump useres that have reached their max med.

I don't have a problem with mag at all. We usually give a 4 grams load over about 30 minutes then 2 grams/hr forever. Some get up to 3 grams/hr, some as little as 1 grams/hr.

We have another nurse witness all mag loading doses (q 15 VS/sats and 1:1) and any rate changes. We do q 4 hour VS, DTR's and o2 sats thereafter.

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Specializes in Maternal - Child Health.

Having been treated for resistant PTL with both of my pregnancies, I can vouch for the fact that MgSO4 does indeed cause each and every miserable side effect mentioned above. I am also quite certain that without the drug, both of my daughters would have been delivered extremely prematurely.

I went into PTL at 26 weeks with my first, and 23 weeks with my second. I tried every drug and treatment regimen imaginable, including bedrest, continuous monitoring, antibiotic treatment for possible sub-clinical infection, brethine (very quickly became ineffective), procardia (bottomed out my blood pressure), and indocin (reduced my amniotic fluid to dangerously low levels). MgSO4 was the only drug that was safe and effective for me, and I was on it for stretches of 3 weeks at a time. Like ANY medication, it has the potential for side-effects that are both annoying and truly dangerous. That is why it has to be monitored so very closely. But with time, I did develop a tolerance, so to speak, that enabled me to function somewhat despite the drug. Also, because I spent much of my second and third trimesters hospitalized, the nurses knew me very well, and were attuned to any changes in my condition, enabling them to respond to minor changes in a timely manner. While I certainly experienced many side-effects of the drug, I was never in any danger because of the excellent, attentive nursing care that I received.

We continued treatment until 37 weeks with my oldest, and she delivered 2 days later. With my second, we decided that the risks of continuing the drug past 36 weeks out-weighed the benefits, so we stopped it at that point, and she delivered the next day.

I firmly believe that like ANY drug or treatment, MgSO4 can be safely used when the benefits outweigh the risks, and nursing and medical treatment are individualized to the patient's needs.

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The article you referenced is exactly correct. There are some pretty scary and uncomfortable side effects associated with Mag Sulfate therapy for PTL. But I think the "side effects" and conditions caused by prematurity are much scarier. I have used every PTL drug out there at my previous hospital. If someone came in with PTL and possibly had a +Fetal Fibronectin test our Perinatologists would hit them hard with tocolytics. Usually first was Terb, if that didn't work we hit them with the Mag. We constantly monitored there heart rate, 02 sats, and resp and BP. Mag was used for 48 hours for steroid therapy then mag was weaned off and Procardia started usually along with Indocin(only for the recommended time, due to possible side effects like oligo, closure of PDA etc.). Pts usually went home on Procardia and did very well. I loved taking care of the antepartum moms and in the 3 years I was at that hospital I only had one pt develop pulmonary edema. I think it happened because she started having breakthru UCs at night, I called the doc, and he told me to give her one dose of Terb SQ. She was on Mag and I questioned the order and reminded him how much mag she was on, he said he realized that and to go ahead. By the AM she had mild pulmonary edema and broke her water because she was coughing so badly. Those twins were delivered that day, both mom and babies did well.

I think most of us that administer Mag can vouch for the fact the pts usually hate the mag at first and feel like hell, but they adjust quite well in several hours. Not all pts adjust, some are miserable the whole time. Its risks vs. benefits, most of the time benefits outweigh the risks for Mag.

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yikes! a nitro patch. i had nitro for r/o mi and had such an awful headache that i vowed never to take it again. are we talking about the same nitro???

mag isn't much better. but you gotta weight the benefits.

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Specializes in L&D.

The only time I've used a Nitro patch on an OB patient was to relax the uterus to replace a uterine inversion.

Yes, Mag Sulfate is a dangerous drug. There is NO drug that is not dangerous in some way. Any time any drug is used, the risk of the condition being treated must be weighed against the risk of the drug being used to treat it.

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