Magnesium sulfate

E&RMommy

It was being discussed below and I didn't want this to get lost!  Tocolysis (of any kind) has never been proven to work in randomized controlled trials.  Period.  I know - it's crazy since so many of us have kept cooking our babies for weeks and weeks being on them.  But if you go strictly by evidence based medicine, tocolysis has really only been proven to help get steroids on board.  There are many hospitals I have been to or worked at where they do not tocolyze (except for 2 days to get steroids) and their preterm delivery rates are identical to hospitals that routinely tocolyze long term.  Many groups (if they tocolyze) have long since given up on meds like magnesium sulfate and terbulatine due to the side effects.  There is no right or wrong....we all have different doctors who choose to use different meds.  You will find that certain doctors are "treaters" and others are "watchers".   

With that being said, I did want to mention magnesium sulfate.  There is new evidence that magnesium sulfate when given within 24 hours of delivery is neuroprotective.  It reduces the risk of intraventricular hemorrhage as well as possibly other neurological problems.  This research has been out for about a year or so and is becoming the standard of care.

So while I agree that routine use of magnesium sulfate for long term tocolysis is very controversial, the use of it for a patient who looks like they might be delivering is actually helpful to protect the brain of the infant(s) should delivery occur.  We have started using magnesium again on our service for PTL while we give steroids and then will reassess whether or not to continue its use.  We haven't used it for this purpose in our hospital in well over a decade.  Heck I am having to retrain myself and it's not easy! 

Ok that's it!  Just wanted to put in that plug for mag since I have had to relearn its use.    Have a great night ladies. 

goldengrace

Thanks for the info, its so great having you on here to make sense of all this!

 

macchiatto

You rock.
That is all.

pea-kay

Yeah, seriously, why couldn't you have been on here three years ago?

E&RMommy

pea-kay:

Yeah, seriously, why couldn't you have been on here three years ago?

I was an intern...I didn't know much then! 

pea-kay

E&RMommy:

pea-kay:

Yeah, seriously, why couldn't you have been on here three years ago?

I was an intern...I didn't know much then! 

you probably knew more than my OB! 

anyalee

Yeah, the Dr. on call here told me if she thought I was actually going to have the babies in the next 24 hours she would really push for the mag because it helps the brain. 

Mrs. Destructo

My peri/hospital wouldn't give me long-term tocolytics. I begged, and they just wouldn't do it. I was given mag at 26 weeks for 48 hours, long enough to get the steroids in. Then we watched and waited. I managed to keep the kids cooking until 30 weeks, with no other drugs aside from occasional ibuprofen to help calm my irritable uterus (I think I took maybe 4-5 doses of it during those 4 weeks).

 When I went into labor again at 30 weeks I begged for mag and they wouldn't give it to me - they said it wasn't worth the side effects because indocin + terb wasn't slowing my contractions & there was little to no chance the mag would help. Interesting about the IVH link, though. If I had known that then I would have demanded mag the day I delivered!

janjag

thank you so much for posting this.  i've wondered what your experience with this and other tocolytics was.

it is interesting (and at times scary) how doctors/hospitals treatment choices are often not based on sound research, but on politics, patient expectations, even habit. 

having had blood clots, PEs, infertility, ivf, and a difficult multiples pg all in my 30s i've come to meet so many doctors with different opinions.  that is just my non-medical, personal opinion.