Long-term magnesium sulfate tocolysis and maternal osteoporosis in a triplet pregnancy: a case report.

Prolonged infusion of magnesium sulfate has been used for the treatment of refractory preterm labor. Long-term magnesium sulfate tocolytic therapy either alone or in combination with other tocolytic agents has been reported to be safe and effective with minimal maternal side effects. There has been only one previous report of a disturbance in maternal calcium homeostasis, which included decreased distal radius bone density and hypercalciuria as a result of prolonged magnesium sulfate infusion. This article reports the first case of bilateral fracture of the calcanei in the postpartum period secondary to osteoporosis associated with prolonged magnesium sulfate tocolysis and bed rest. A 35-year-old white female with a triplet pregnancy of 25 weeks' gestation was admitted in preterm labor. Bed rest, intravenous magnesium sulfate tocolysis, and intermittent subcutaneous terbutaline were necessary to maintain uterine quiescence for 65 days. The patient received weekly betamethasone for 6 weeks for the acceleration of fetal lung maturation. Daily prenatal multivitamins and low-dose subcutaneous heparin for thromboprophylaxis were given. Efforts at tocolysis were ultimately not successful and the patient underwent a cesarean section delivery at 34 2/7 weeks' gestation. The patient's postoperative course was complicated by osteoporosis and bilateral stress fractures of the calcanei. This case report demonstrates that stress fractures secondary to osteoporosis may be associated with prolonged magnesium sulfate therapy and bed rest in higher order multiple pregnancy. Other possible contributing factors to osteoporosis include heparin thromboprophylaxis and suboptimal calcium supplementation. Therefore, in circumstances of prolonged bed rest and magnesium sulfate tocolysis, additional daily calcium supplementation would be well advised.

An adult development study of contextual memory.

This study tested the hypothesis that there is a relatively greater decrease in memory for contextual features than in memory for target information with increasing age. Young, middle-aged, and elderly adults were presented with a number of slides, each of which contained a word centered on a background composed of either a landscape/cityscape or a border design. One third of the subjects were told to remember the words, one third were told to remember the backgrounds, and one third were told to remember the word-and-background pairs. Recognition memory for both words, backgrounds, and word-and-background pairings was tested in all subjects. The interaction between age, instruction condition, and type of information tested was not significant. Thus, there was no support for the hypothesis that older adults have a greater deficit in contextual memory than in memory for target information when compared to younger adults.