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Magnesium Vs Nifedipine In Preterm Labor


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#1 HTmonkey

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Posted 31 January 2008 - 12:19 AM

Hey,
Wondering if I'm behind the times or what. Picked up a pt given nifedipine for preterm labor and I was wondering WTF? I remember giving that stuff back in the day for HTN. So I looked it up and learned all about it. Sounds cool and easy, less side effects blah blah blah. My PDA with Pepid seemed to indicate mag went out of style bigtime. However my protocol is still mag and terb for preterm labor. What is everyone else doing out there??? If you have switched to Ca channel blockers you got any data I can forward to our clinical care committee? Thanks
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#2 Macgyver

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Posted 31 January 2008 - 05:47 AM

Hey,
Wondering if I'm behind the times or what. Picked up a pt given nifedipine for preterm labor and I was wondering WTF? I remember giving that stuff back in the day for HTN. So I looked it up and learned all about it. Sounds cool and easy, less side effects blah blah blah. My PDA with Pepid seemed to indicate mag went out of style bigtime. However my protocol is still mag and terb for preterm labor. What is everyone else doing out there??? If you have switched to Ca channel blockers you got any data I can forward to our clinical care committee? Thanks


Here is the whole problem with EBM. If there are no studies done, there isn't any evidence to support "x". And mag is generic so why would a company fund research comparing it to something else that costs more and may not be as effective. The problem with mag is that if given too late it won't work and gives you a flat baby. Often however it IS given too late and too little.

Mag has been used for years all over the world, and if approriately given (dose, early in the labour etc) it woks a lot of the time. Anectotally but worldwide. Not a high power EBM finding however. various ca blockers have also been tried as have ventolin/albuterol (iv even) and all have thier effective uses and limitations. Really comes down to what your OB doc/med advisor wants to use. In Canada we don't have access to terb, mag is common, nifedipine less so and ritodrine well on its way out. There was even a study on using ntg - no real improvement over mag I believe.

The essential thing is to interrupt any one (or more) of the pathways that promote the movement of the fetus down the birth canal (by supressing muscle activity, blocking chemical or hormonal pathways/signals etc). Which one to block and how to do it best is the question - i happily defer to that decision to the OB/GYN's and midwife RN's on the list!!
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Ken BHSc, RN, REMT-P

#3 JLP

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Posted 31 January 2008 - 06:26 PM

[quote name='Macgyver' date='Jan 31 2008, 12:47 AM' post='6085']
Here is the whole problem with EBM. If there are no studies done, there isn't any evidence to support "x".

Funny, I was having the same conversation with one of our docs, I was asking why Dilantin is so little used as an antiarrythmic when many ICU docs and cardiologists I know swear by it - I got the same answer pretty much word-for-word, pointing out that AHA guidlines are based on current research - no big money in selling an off-patent drug, so no new research.
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