Mag sulfate

[growlie]

Hi friends,

I am scheduled to be induced Monday night with cervidil or Tuesday morning depending on if I am dialated on Monday. The L and D nurse that came to talk to me about it said that I would probably have mag. I have PIH (good bloodwork/low protein) and since being on labetalol my BPs are 130s/70-80s consistantly, although overnight a bit lower than that while sleeping.

I understand that mag can be both a miserable experience and lifesaving drug. I won't fight with them if they say I need it. But I am wondering when it typically is used if you don't have pre-e? If BP is well controlled on medicine, would mag just automatically be used? The nurse through me for a loop because I have seen an awful lot of doctors here and only one mentioned that it MIGHT be needed, but they went into great detail about what to expect otherwise with the induction.

I know I am worrying over something completely out of my control (because if the doc says its needed, I am getting it), but I am curious if that is just standard procedure for most PIH patients.

Thanks for sharing your experience, and sorry if this has been previously answered. Internet access isn't great in the hospital, so I didn't search the site very well.

[jenh]

I don't know if it's necessary for your case or not, but I can tell you I did have mag for my first birth (severe PE with CNS involvement, borderline HELLP), but not with my second (mild PE) or during labor with my third (mild PE that turned severe post partum; I did have mag post partum, but not until it was clearly necessary.) So I don't think it's standard to always give mag for PE or PIH. It depends on the specific circumstances.

[amberstrika]

Hello!

I have personally had the mag drip on three separate occasions. I had NO idea about it's terrible reputation until just recently. I was like "really? That thing? Surely they must mean something else..." I had it all three times due to my preeclampsia, which I'm sure is why you are having it. I'm one of those people that if there is a side effect to a medication I feel it. I'm such a wuss like that. I can't believe the horror stories people tend to tell about it! I mean sure, it's not an awesome experience, but it's realllllly no big deal. Would I go in and get it for fun? No, but even still. After going through the trauma that is birth, it's like a piece of cake. Here's how it was for me: They came in warning me that it wasn't going to be very pleasant. My eyes got really dry (visine cleared it up immediately) and my body felt hot all over. It didn't hurt, I just felt like I was too hot. A nice cold washcloth was very soothing and made me comfortable. And viola! That's all there was too it. If you have ever been outside on a hot day and felt uncomfortable, then you've experienced a mag drip. Definitely no fun, but nothing to be afraid of. And if you are really scared, you can do like I did my last pregnancy. I told them I was really nervous, and they gave me something to calm my nerves. they then proceeded to give me the mag drip and I was blissfully unaware of it completely. I don't even remember them giving it to me. It was the easiest thing in the world. And with our conditions, it is a life saver. i would recommend you get it 100%! If you are truly nervous, make them give you something relaxing and you won't even feel it! For all the other things we have to worry about childbirth and our preeclampsia, I's rate the mag drip as the lowest on the totem pole. Going poop for the first time after was a million times worse!

Best of luck!

[amberstrika]

Oops. I realize I didn't really answer your question. they give you the mag drip to control your BP and prevent seizures. With preeclampsia, even if you have it under control via meds or bedrest, your BP can suddenly spike during labor. That spike can be extremely dangerous. They give you the mag to prevent you from getting a sudden spike and having an eclamptic seizure. It's a preventative measure, and a very important one.

[growlie]

I understand its importance, as I said. But I haven't been diagnosed with pre-e. That's what I was more wondering about. If you just have PIH, and labetalol is working like a charm, is it a forgone conclusion that I will get mag?

[amberstrika]

labetalol may be working like a charm right now, but labor is a whole new beast. Preeclampsia or not, you have blood pressure problems. And going into labor with blood pressure problems is dangerous. It takes your body some time to adjust to the blood pressure medications before they are steadily working. And during labor you do not have enough time to get adjusted to the medication. That's why they give the mag drip. For immediate protection and blood pressure stability. If your practitioners are concerned enough to tell you you need it during labor, I think it would be safe to assume they are taking your medications into account and determining that it is still necessary.

[hillary8l8]

I had PIH alone with my first pregnancy with no significant protein in my urine. I was well controlled on 200 mg Labetalol 2 times a day up until the end when I was hospitalized at 36 weeks. My pressures were running anywhere from 120/80s while laying on left side to 150s/90-100s while sitting up. I was induced at 37 weeks, and mag was only mentioned by one nurse, but she didn't say it would "probably" be used, just that it could be if absolutely necessary. They ended up not having to use it because my pressures thankfully stayed good during delivery. But this is only my case, I'm not sure what the general recommendations are. I want to mention too that my OB elected for a "slow induction" as he called it because it would be less stressful on my body, and less likely to raise my pressures. I don't know if this is general practice, I think it probably is not from what I have seen on these boards. It seemed to work for me though. He started with a low dose of Cervidil the first morning, another low dose in the afternoon, another low dose the next morning, and then I went into labor myself the next day with no Pitocin. I ended up delivering my daughter at 3:54 pm the second day. He said the "slow induction" could take up to 3 days, and I started the induction with my cervix being thick and closed.

[alviarin]

I think it depends on the doctor. I had an induction for mild preeclampsia with no magnesium sulfate, but now I wonder if I shouldn't have been on mag as a precaution.

That being said, other feeling a little hot at injection site mag doesn't really phase me. I was on it for my first delivery and I have been on it even when not pregnant as part of an iv cocktail to break a migraine.

[blythe]

Has your induction started yet?

From what I understand, mag for mild PE and for PIH isn't required and is very dependent on your doctor's comfort level.

My understanding is that eclampsia has less to do with bp or bp spikes than with central nervous system involvement. "The" PE headache, visual disturbances, and hyperreflexia and/or clonus (why they keep pressing on your feet and ankles) are the signs they look for that you might have CNS involvement and are therefore at risk of eclamptic seizures, whether you have protein and meet the official diagnostic criteria or not.
http://www.ncbi.nlm.nih.gov/pubmed/18495165
Eclampsia is a poorly understood disorder characterized by seizures or unexplained coma in setting of gestational hypertension...Headache preceded seizures by more than a day and was described as throbbing or pounding pain by most. The visual symptoms in decreasing frequency were blurring, blindness, scotoma and visual processing deficits. The most common finding during the neurological exam was memory deficits, followed by increased deep tendon reflexes (asymmetric in some), visual perception deficits, visual information processing deficits, altered mental status and cranial nerve deficits.

If you're geeky like me you can search pubmed for more info. Here's an article on why they think mag helps (short version, they're actually not sure but they have lots of educated guesses) http://www.ncbi.nlm.nih.gov/pubmed/19211496

Good luck!