Threatened preterm labor

[rnWinn]

Hey all,

What is the common practice where you work regarding preterm labor? What makes your docs decide on using Mag Sulfate vs. Brethine vs. Indocid? What are the protocols like (dosages etc). Also, at what point is it considered "too late" for these meds?

We don't use Mag or Brethine in Canada for prem labor, Indocid we use with caution...

[bagladyrn, RN]

I'm working a contract in High Risk Antepartum right now and what I'm mostly seeing is terbutaline SQ used as an immediate treatment (see if it knocks the contractions out quickly) then nifedipine PO or SL around the clock, then if nothing else works the magnesium sulfate is started IV. Doses on all but the SQ Terbutaline vary 0 usually starting with the low doses and working up. The big emphasis, except in very preterm cases seems to be on "buying time" for steroids to work or adequate doses of antibiotics to be effective if positive GBS or BV.

[RNLaborNurse4U]

For us, it depends on the doctor's group. The maternal fetal medicine docs will usually go to Magnesium first. They will also usually implement procardia after 24-48 hrs on Mag, and start to wean the Mag off. Another group, they will go with terbutaline SQ first, followed by terb p.o. q 4 hrs. Still another group, they use Procardia q 6 hrs.

I like terb SQ as an immediate treatment, personally. The cut off for that is over 37 weeks. Also contraindicated/used cautiously in preeclamptics and hypertensives.

We don't give betamethasone over 34 weeks, but we do implement it immediately on anyone under 34 weeks, to try and buy the 24 hrs dosage time (12 mg betamethasone IM q 24 hrs x 2 doses).

Mag - 4 gm loading dose over 20 min, then standard dose is 2 gm/hr. Sometimes, they leave the women on Mag for far, far too long (weeks and weeks).

We rarely use Indocin. If it's used, it's for less then 48 hrs only, due to the risk of the ductus arteriosis closing prematurely in the fetus, as well as leading to oligohydramnios. Usually, it's the MFM docs who use Indocin.

[NurseNora, BSN, RN]

Our first treatment is usually SQ Terbutaline, followed by PO Nifedipine or Terbulatine. We only use MgSO4 for tocolysis on the patients we transport, because that's what the Perinatologists we transport to use.

For someone less than 30 weeks, we might use Toradol or Ibuprofen. I haven't seen Indocin used in many years.

[crysobrn]

Our protocol for preterm labor is terb .25mg SQ and then may repeat after 5 min if necessary and not contraindicated. Hydration, usually a 500cc of LR followed by 125 per hour (also unless contraindicated). If we are still seeing contractions we start mgso4, usually a 4gm loading dose followed by 2gm per hour. And at this point if they we use the betamethasone (under 34ish wks). All of this is done on a case by case basis. I've seen moms get a dose of terb and go home on nothing, and have also seen them go home on po terb or procardia... it depends on the doc and the situation.

We transfer patients that are under 34-35 wks (no nicu) depending on the situation so many times we are also starting antibiotics for unknown gbs status as well as contacting the perinatologists to see what else, if anything they would like to see done.

I've never seen, or used indocin...

[DEB52]

I work in the hospital that receives the transports from other hospitals in our area. We are a level 3 hospital with perinatologists and neonatologists. Our antepartum unit is separate from L/D and has 30 beds. With all that said, we have seen it all used. It all depends on the gestational age, pt.'s medical hx, doctor preference and which medication works for that patient.

As for magnesium sulfate, the average bolus for us is 4 to 6 gms given over 30 mins then an 2 to 3 gms/hr infusion. Procardia is usually 20mg every 4 or 6 hr. Indocin is usually 50mg loading dose either po or rectal supp. then 25 mg every 4 hr for 72 hrs. I've seen Indocin 50mg every 6 hr. for 72 hrs. After the Indocin is finished Sulindac 200mg q12hr is started. We do also usually use Terbutaline 0.25 mg sq prn as needed OR 5 mg po every 4 hrs.

Some of these drugs are used together; usually Magnesium sulfate and Procardia. But sometimes I've seen them add Brethine po to this combination. This has increased the patient's chance of pulmonary edema so magnesium checks and accurate I/O are very necessary.

Happy Labor Day !

[KimBicRN]

I am in PA (suburbs of Philly)...we use terb initially and then procardia as needed. We no longer use Mag. Sulfate (many years now), being that it is no longer recommended for use in cessation of preterm labor