Question for you, do you think Terbutaline is overused?

  1. I am just curious about this and since I am still a student I figured this would be a good place to ask. Here's why I am asking. I was up to L&D last week because I was having regular contractions about 5-6 minutes apart for a few hours. I was 32+ weeks at the time. This is my 5th baby so for the most part I do expect to get more contractions and had I been past 36 weeks no way would I have gone up to be checked. I have a history of very fast labor so I figured better safe than sorry go get checked. All of my other children have gone full term so I really wasn't too concerned. I did do something similar with my last pregnancy, but the contractions never dilated me. They just made me a little crazy, lol. Anyhow, I am with a new OB group and they seem a bit more aggressive than my last. The contractions did show up on the monitor, but not as close as they were at home so they gave me a shot of Terbutaline. They checked me I was not dilated, still long, but soft. They sent me home with a prescription to take every 4 hours for the contractions. I honestly think they gave this to me to pacify me not because they really think I need it. They didn't put me on bedrest, nor did they give any restrictions on sex or any restrictions on anything which leads me to feel that the prescription is unnecessary. I also post on a pregnancy board and have seen quite a few other moms prescribed brethrine that are not dilating or showing any cervical changes. I have to wonder if it is necessary or helpful to take it. Anyhow, not sure if my question is coming out quite how I want it to, but just curious of your experience with this.

    Thanks for your feedback
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  2. 5 Comments

  3. by   Jolie
    It does seem curious that you were prescribed medication without having cervical changes, and, more importantly, without less invasive measures such as bedrest, hydration, and other restrictions being tried first.

    Were you checked for a UTI? This is a common cause of pre-term contractions, and it may be difficult to notice symptoms, as most pregnant moms at 32 weeks have to pee constantly anyway.

    I was taught that pre-term labor consists of contractions AND cervical changes, and warrants medical interventions. I am not accustomed to seeing pre-term contractions (without cervical changes) being treated so aggressively.

    Terbutaline is generally well-tolerated, but is not without potential side-effects to both mom and baby. I would ask for clarification on how long to take it, and exactly what side-effects to watch for. Also, you should be seen in the office on at least a weekly basis while you are taking this med.

    Good luck. Let us know how things go!
  4. by   ShandyLynnRN
    it is not uncommon with our OB group to do terb with preterm contractions without dilation... up through 37 weeks. We always try IV hydration first, and they are usually put on "light duty" type activities and no sex, but not bedrest unless cervical changes have been made.... ofcourse, if there are cervical changes with them, they are usually shipped out to a higher risk facility since we are just level one.
  5. by   TeresaRN2b
    Thanks ShandyLynn, now I don't feel so silly taking it. I just had always thought they didn't give it to you unless you had cervical changes.
  6. by   HazeK
    our Perinatologists do the "po hydration...if needed, iv hydration...if still contracting, sq terb series of three...if still having painful contractions, Mag Tx"
    routine around here up til e35 weeks! VERRY conservative about letting folks deliver before then, if at all possible! If tocolytics not working well, between 32-36 weeks (i.e. lots of contractions) may do amnio and, if mature, take them off tocolytics and see what happens....some deliver, some don't!
  7. by   OBNurseShelley
    the Level III facility I used to work at, was very conservative about using terb. If they REALLY thought someone was having PTL they would opt for mag and steroids, otherwise hydration, bedrest, etc. I just started working at a level II facility and terb around here is like water, EVERYBODY gets it, for PTL and PO terb is used ALL the time. If you ask any intelligent perinatalogist, they will tell that you PO terb is a waste of time and $$$
    Just last night i had a pt come in at 33weeks, with PAINFUL regular ctx's, bloody show and dilted to 1/50/posterior. she got iv hydration and sq terb x3 doses, and steroids, the next day she was switched to PO terb. If this had been at my other facility this patient would have immediately been put on mag. Interesting how different facilities operate.

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