"Not using terbutaline anymore"

webbiedebbie · May 28, 2004

Sounds like the patient had her mind made up. I have not heard of terbutaline being stopped. It will be interesting to see if others have heard of this.

I do hope the patient understands the consequences of a preterm birth. Sometimes the risks of using medication outweigh the risks of preterm births.

SmilingBluEyes · May 28, 2004

we continue to use terb, unless contraindicated in a certain medical condition, where I am. The belief is benefits outweigh any risks, where we are.

gypsyatheart · May 29, 2004

Just have to ask, because I don't trust the source of info.
Had a PTL patient last night who refused both terbutaline and MgSo4 to stop the contractions. She and her mother then both insisted they heard a report that all use of terbutaline to stop preterm contractions was going to be stopped as they have found that it "does things to the baby" and that the state of California was no longer using it.
I tried to tell them I just completed a travel assignment out there in October and that it was still being used (in fact, quite frequently). They then told me that this just started 2 weeks ago, but couldn't remember where they heard it.
Has anyone else heard this?
I don't really believe them as they exaggerated alot of things last night, and the patient then told me "I just want to have this baby. I'm tired of being pregnant and I had my other 2 this early and they were fine."

We are still using both terb and MgSo4. This is one of those "brilliant" patients that need a tour of the NICU!

kastas, BSN, RN · May 29, 2004

We are still using both terb and MgSo4. This is one of those "brilliant" patients that need a tour of the NICU!

I was just thinking the same thing. I love the "I know more than you know" patients. :angryfire Probably took her birthing classes by watching A Baby Story, too. :rolleyes:

BRANDY LPN · May 29, 2004

Hmm, musta missed that memo.

Dayray, RN · May 29, 2004

Yep.. tour of the NICU. Have these types of patient from time to time and a tour sometimes cures them. Anyone else had a patient say "well if the baby wants to come out , it must be ready!" ? Not sure how they can believe that their 25 weeker is going to be fine on the outside. Some of them still say the same thing after seeing the other babies on vents =(

As for the use of Terb, there are a couple of OB residents that are always expounding on how dangerous terb is, so I just ask them to compare the risks of its use with the risks to severely preterm infant and they shut up.

fiestynurse · May 29, 2004

...

mitchsmom · May 30, 2004

Apparently your patient had been watching the news, check out these headlines:

http://drugs.mongabay.com/medications/Terbutaline.html

I understand that the benefit may be worth the risk, but this is probably what she was referring to - she probably had just enough info to make a dangerous decision without a fuller understanding of the whole picture. Too bad her doctor couldn't discuss it further with her.

Here's a short NYTimes article on it:

http://www.nytimes.com/2004/04/06/health/06RISK.html?ex=1085976000&en=1544f2b2be5fd7ee&ei=5070

A drug prescribed to prevent premature births may leave children's brains especially vulnerable to the damaging effects of environmental pollutants, a study of the drug in rats suggests.
Researchers from Duke, writing in last month's Toxicology and Applied Pharmacology, said the finding might explain why some children whose mothers were given the drug, terbutaline, had been shown to be at higher risk for learning and behavioral problems.
The senior author of the study, Dr. Theodore A. Slotkin, cautioned against overreacting based on tests on animals. Still, he said, "the effects we see are real."
Assessing the effects of terbutaline in humans is hard because mothers who are given the drug are more likely to give birth prematurely, and their babies are already at higher risk for developmental problems, Dr. Slotkin said.
The researchers studied young rats that were first given the drug, and, in some cases, were later exposed to the widely used insecticide chlorpyrifos. The rats exposed to the drug and the insecticide suffered worse damage in areas of the brain involved in learning and memory than did rats in other groups, the study said.
In addition to suggesting that exposure to some chemicals early in life may affect learning, the research found that the drug and the pesticide seemed to worsen each other's effects.
When women go into premature labor, a complication in a fifth of pregnancies in the United States, doctors work quickly to try to stop it. According to the American College of Obstetricians and Gynecologists, premature birth is the leading cause of infant death and a major cause of illness. Although terbutaline is commonly used, the group says, there is no good evidence for its effectiveness.

But I haven't found anything about California.

Here's the OB/GYN.net article:

http://www.obgyn.net/newsheadlines/womens_health-Obstetrics-20040422-120.asp

dansamy · May 30, 2004

I kinda understand/empathize with mom. All 3 of mine were pre-term due to pre-eclampsia. A 30wkr, a 33wkr, and my "big" baby at 34w2d. None of them needed vent, cpap, etc. They were "feed & grow" kids. My ob & the neo both thought the "stressful" womb environment with the preeclampsia hampering placental function sorta "accelerated" fetal development. They were smaller than "average" for their GAs, but not small enough to be IUGR. All in all, I was very lucky to have good outcomes. I know it doesn't always happen. I'm grateful it happened to me.

Dayray, RN · May 30, 2004

A preeclamtic mom is a totally different situation. You really cant compare this to a patient that just thinks "the baby wants to come out". If you are severely preeclamtic then it's a balancing act. what I mean is the Ob has to weight the risk too mom by staying pregnant with the risk to the fetus being premature.

In preeclamcia preterm delivery can be the lesser risk. So yes it can be valid to deliver that early but it's not a good comparison to a healthy mom that wants to deliver early.

gypsyatheart · May 30, 2004

A preeclamtic mom is a totally different situation. You really cant compare this to a patient that just thinks "the baby wants to come out". If you are severely preeclamtic then it's a balancing act. what I mean is the Ob has to weight the risk too mom by staying pregnant with the risk to the fetus being premature.
In preeclamcia preterm delivery can be the lesser risk. So yes it can be valid to deliver that early but it's not a good comparison to a healthy mom that wants to deliver early.

EXACTLY!! PTL in an otherwise healthy mom and a sick pre-eclamptic are two very different things. I don't empathize with these women at all. They are giving no regard to their baby. Unfortunately not all pre-termers are lucky enough to be just "grower-feeders". Even so, I would never want my baby in a NICU environment! Lay people have no idea what their baby goes through in a NICU.