Mag or bust
What is considered therapeutic range for magnesium?
4.8-9.6 mg/dL or 4-8 mEq/L
What medication (and dose) has been shown to have a significant reduction in severe preeclampsia as well as fetal growth restriction when started before 16 weeks gestation?
Aspirin 81 mg daily
You are evaluating a laceration status post forceps assisted vaginal delivery and note the defect all the way through the rectal mucosa, what medication is reasonable to give at the time of repair?
Single dose 2nd generation cephalosporin (cefotetan or cefoxitin) or clindamycin if PCN allergic
30 yo G1P0 with history of MRSA colonization is undergoing scheduled CS due to breech presentation. What is the appropriate antibiotic prophylaxis?
Vancomycin + (cefazolin or gentamicin+clindamycin)
Which medication is more effective than phenytoin, diazepam or nimodipine in reducing eclampsia in the intrapartum and postpartum periods? What typical dose do we administer at?
Magnesium sulfate. 4-6 g bolus followed by 2 g/hr
300 mg.
Given 10-20 mg, then 20-80 mg q 10-30 min
A patient presents to L & D with BP 195/105 reporting significant HA. Upon arrival, she begins having a tonic clonic seizure. She has no IV access. What do you give?
Magnesium sulfate (IM injection) 5 g in each buttock
How about if the c-section is performed after the patient has labored to 6 cm and undergoes arrest of dilation?
Cefazolin (1 g if < 80 kg, 2g if <120 kg, > 80 kg, 3g if > 120 kg - though not studied in obstetric surgery) or clindamycin (900 mg) + gentamicin (5 mg/kg)
Azithromycin 500 mg added if laboring to cover for atypical bacteria
What are the contraindications to magnesium?
Myasthenia gravid, severe renal failure, cardiac ischemia, hypocalcemia, heart block, myocarditis
What are three common antihypertensive medications for persistent severe hypertension?
IR PO nifedipine
IV labetalol
IV hydralazine
A patient on magnesium who's most recent creatinine was 1.8 develops somnolence, decreased O2 saturations and respiratory rate? You suspect respiratory depression from magnesium toxicity. What do you administer for emergency correction of magnesium toxicity?
IV furosemide (accelerate urinary excretion)
What is treatment of choice for chorioamnionitis? Endometritis?
Chorioamnionitis: Ampicillin and gentamicin. If CS, one additional dose of chosen regimen + clindamycin or metronidazole
Endometritis: clindamycin and gentamicin (addition of ampicillin for GBS +)
At what magnesium level can loss of deep tendon reflexes occur?
What about respiratory depression or cardiac arrest?
Loss of DTR - 9 mg/dL
Respiratory depression - 12 mg/dL
Cardiac arrest - 30 mg/dL
What oral agents are commonly used to treat HTN in pregnancy?
Labetalol, nifedipine, methyldopa, HCTZ
A patient undergoing cesarean section for dichorionic diamniotic twin gestation received 2 g cefazolin within 1 hr prior to the procedure. EBL during closure of the hysterotomy is noted to be 1800 ml. What antibiotic should be given?
an additional dose of ancef 2 g
When to redose antibiotics?
- when surgical procedure last > 2 half lives of the antibiotic
- excessive blood loss, > 1500 ml
G3P0111 presents with premature preterm rupture of membranes at 30w3d. She is comfortable with no contractions noted or seen on TOCO. What is the appropriate antibiotic prophylaxis?
"Latency antibiotic"
Per ACOG: IV erythromycin and IV ampicillin x 2 days followed by 5 day course of oral amoxicillin and erythromycin
At WVU: IV azithromycin and IV Ampicillin-sulbactam x 48 hours followed by 5 days amoxicillin