The Journal of Maternal-Fetal Medicine 6:296–297 (1997)

Magnesium Tocolysis as the Cause of Urinary

Calculus During Pregnancy
Hiroshi Sameshima, MD,* Takafumi Higo, MD, Yuki Kodama, MD, and Tsuyomu Ikenoue, MD
Perinatal Center and Department of Obstetrics and Gynecology, Miyazaki Medical College,
Miyazaki, Japan

Abstract Twenty-one days of magnesium sulfate tocolysis were performed on a 28-year-old woman because of
preterm labor at 31 weeks gestation. In association with this tocolysis, urinary calculus of magnesium ammonium
phosphate occurred at 34 weeks gestation. J. Matern.–Fetal Med. 6:296–297, 1997. r 1997 Wiley-Liss, Inc.

Key Words: magnesium; tocolysis; urinary calculus; pregnancy

INTRODUCTION
Magnesium ammonium phosphate is the type of calculus
very commonly associated with infection. We present a case
of pregnant patient with magnesium ammonium phosphate
calculus, who undertook magnesium sulfate tocolysis for 3
weeks without clinical infection. We discuss the association
of magnesium tocolysis and urinary tract stone formation.
CASE REPORT
A 28-year-old, gravida 3, para 2, Japanese woman was
transferred to our hospital due to preterm labor at 31 weeks
of gestation. She had no previous urologic disorders. A
catheter urine specimen taken on admission had a pH of 7.0
and was negative for bacteria.
The patient’s obstetric history revealed that she had
experienced side effects of ritodrine, causing maternal
tachycardia of more than 120 bpm. Thus we chose to use
magnesium sulfate as the tocolytic agent. Four grams of
magnesium sulfate were administered intravenously, fol-
lowed by a maintenance dose of 1–2 g/h. Plasma concentra-
tions of magnesium and calcium were measured every 2 days
and maintained at between 4.7–6.6 mg/dl and between
6.0–6.4 mg/dl, respectively.
During the remainder of her pregnancy she had intermit-
tent contractions with a slight ripening of the uterine
cervix. We continued magnesium infusion and kept the
patient on bedrest. Weekly urinalyses and urine cultures
were performed and showed no specific findings. Daily urine
production ranged between 1,000 ml and 2,300 ml.
On the 21st day of magnesium infusion, she suddenly
complained of left flank pain, dysuria, and nausea. A urine
specimen revealed a pH of 7.0, one leukocyte per 1–2 high
power fields, and many red blood cells in the sediment. Less
than 103 Staphylococcal species per milliliter were isolated
in the urine. An abdominal ultrasound examination showed
a urinary tract stone with a dilated left renal pelvis and
ureter. Four days later, she voided a white, surface irregular,
hard stone of 2 3 3 3 7 mm in size. The stone was analyzed
with an infrared spectrometry (IR-700, Nihon-Bunkoh,
Japan), which confirmed that the stone was composed of
magnesium ammonium phosphate.
Four days after termination of magnesium infusion, she
delivered a 2,200 g female baby at 35 weeks of gestation.
The baby suffered from respiratory distress syndrome and
responded well to surfactant replacement therapy. Magne-
sium concentration of the umbilical vein was 1.8 mg/dl.
DISCUSSION
To the best of our knowledge, this is the first report to
show an association between long-term magnesium sulfate
tocolysis and urinary tract stone formation. Urinary stones
form when the solute saturation and urine production is
disturbed. Some predisposing factors are known to be
metabolic disorders, hormonal disorders, dietary abnormali-
ties, renal dysfunction, infections, and urinary tract obstruc-
tion. Long-term magnesium administration certainly in-
creases urinary magnesium concentrations. Bedrest also
contributes to urinary stasis. Since the patient had no other
*Correspondence to: Hiroshi Sameshima, M.D., Perinatal Center and
Department of Obstetrics and Gynecology, Miyazaki Medical College,
5200 Kihara, Kiyotake, Miyazaki 889-16, Japan.
Received 14 January 1997; revised 1 June 1997; accepted 2 June
1997.

r 1997 Wiley-Liss, Inc.

 MAGNESIUM CALCULUS IN PREGNANCY
known predisposing factors, we believe that the 3 weeks of
magnesium infusion played an important role in causing the
urinary calculus.
Urinary calculi containing magnesium ammonium phos-
phate had been reported in association with urinary infec-
tion [1]. The bacteria synthesize urease that releases ammo-
nium by metabolizing urea [2]. Common bacteria associated
with stones are Klebsiella pseudomonas, staphylococcus,
and Ureaplasma urealyticum. Although the bacterial count
was ,103 per milliliter, urease producing staphylococcal
species existed in the urine. Therefore, we speculate that
magnesium ammonium phosphate calculus can be produced
with a few organisms capable of metabolizing urea when a
patient is receiving magnesium sulfate.
297
Magnesium ammonium phosphate is the type of calculus
very commonly associated with infection. According to the
current case report, for patients receiving magnesium sul-
fate, we would recommend culturing the urine every week
to see if the urine is contaminated with bacterium forming
urenase. Proper antibiotic treatment may inhibit the forma-
tion of magnesium ammonium phosphate.
REFERENCES
1. Fowler JE: Staphylococcus saprophyticus as the cause of infected urinary
calculus. Ann Inter Med 102:342–343, 1985.
2. Smith LH: The medical aspects of urolithiasis: An overview. J Urol
141:707–710, 1989.