Sunday, 21 February 2010

Like a Dose of Salts

What follows is my interpretation of the use of magnesium sulphate in the treatment of pre eclampsia. I have done research, however I have not referenced as this is a blog and not an essay. Please do not use what I have written as anything but musings and reflection.

When I was a poor student, and unable to buy treats from the Body Shop (and Lush hadn't been invented yet) I used to buy Epsom Salts for a lovely bath time treat. Nothing relaxes the muscles like a dose of salts. (Its used for constipation as well, however I'd rather have prunes thank you very much)

Little did I know then what an important role Epsom Salts (magnesium sulphate) would play in my medical future.

Just to recap a little, at 26weeks + 6 days I was diagnosed with pre-eclampsia. So just what is it? Eclampsia is a Greek word, and it means "bolt from the blue", eclampsia is a massive seizure, and can be fatal.

Pre eclampsia is the state before eclampsia happens. True eclampsia is rare, partly because of good ante natal care, and the fact that pre eclampsia can be spotted and treated. Pre eclampsia though, is somewhat of a misnomer, as eclampsia can happen without pre eclampsia being present. Also it can appear after eclampsia has occured. In some instances pre eclampsia can occur immediately after birth.

No one is really sure why pre eclampsia happens. Some things put a woman at greater risk, such as a first pregnancy, being obese, and having a history of high blood pressure. But equally, many women without any of these risk factors find that they are afflicted with this horrible condition.

Pre eclampsia used to be known as toxeamia. And that is a good description. Occuring after the 20th week of pregnancy, once the placenta is developed, the body starts treating the placenta as hostile. It can then cause the placenta to stop functioning, and the baby to have problems. In Joseph's case he had severe intra uterine growth retardation (IUGR) he should have been 1kilo at 27 weeks, but he weighed just 680 grams (1lb 7oz)

The only cure for pre eclampsia is delivery of the baby. However this needs to be well timed, as pre eclampsia can cause the mother's liver and kidney to stop functioning, so deliver too early by caesarean section, and death can occur. Deliver too late, and of course, the consequences are obvious, full blown eclampsia, and the loss of baby and mother.

This is where magnesium sulphate comes in. Given by infusion or injection, it causes the internal body systems to relax, the blood pressure to drop, and diminishes the risk of eclampsia.

What happens these days, is that if premature delivery is expected, the mother is given two injections of steroids to improve the baby's lungs. (this also plays a role in diminishing the risk of cerebral palsy in extremely pre term infants)

So the magensium sulphate buys some time, for the steroids to work, to stabilise the mother, and to conduct a safe c-section. In many cases, including mine, treatment continues for 24 hours after birth.

So next time you hear the phrase "like a dose of salts" just think how amazing simple Epsom Salts really are.

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