Terbutaline protocol

we don't use it. the MFM gods took it away.

Exactly, I was just going to say that terb isn't used anymore for tocolysis, therefore no policy is necessary.

Here's an ACOG policy statement on preterm labor/delivery that includes info on the use (or NON-use, as the case may be) of terb as a tocolytic. I'm curious, OP, how your facility currently uses it. I know when I worked at a small community hospital where all the docs practiced "this is how I learned in med school, therefore this is how we will always do it" obstetrics, and terb was given regularly in triage for women who presented with preterm contractions. This was 2005-2010. Then I moved to a large city and worked in a university hospital, and I noticed that terb was NEVER given for PTL. Nor had it been given for several years. Gotta love EBP! Edited to add: once in a great while we still use a single shot of terb in cases of active labor when a baby is totally crumping and cannot handle contractions at all, and we will give it, but we are also running her to the OR for an emergent C/S.

http://www.acog.org/About_ACOG/ACOG_Districts/District_XI/~/media/Districts/District%20XI/20120710NeuroprotectionLtr.pdf

We use terb. Not near as much as we used to not as many doses and only as sub q shots, no longer pumps or iv. We don't have a policy and are expected to know the drug we are administering just like any other drug. If you know it, it's risks, it's contraindications and it's side effects you will know when to not give it. This is true with any drug. It got its warning for a reason so we use it cautiously for tachysystole not resolved with other interventions with associated fhr problems, to stop contractions with certain fhr patterns or complications, to stop preterm contractions as a one time option to see if that's all they need or until other therapies or options are available.

Thanks everyone, I will let my manager know. I worked in large high risk hospitals for 8 years, but then took a 7 year break to stay home with the kids. Not using terbutaline is new to me. When I left we were still using terbutaline pumps.

Our OB-GYN here still uses terb SQ occasionally, but now I know why the family practice only do one shot at a time instead of the old protocol of 3 q 20 minutes. It's nice to hear what other places are doing.

Why is it not used? I received two times during my pregnancy with my now 2-year-old. The first time was 29 weeks and I was contracting due to dehydration despite receiving 4 bags of IV fluids and I wound up getting 2 shots before everything calmed down. The second time was 31 weeks, same situation, only took one shot to stop the contractions. Both times were sub-cu. The third time I had premature contractions I was 36 weeks, so they wouldn't stop the contractions but couldn't administer pitocin to start labor, so I was given pain meds/muscle relaxers and put on bed rest.

Because a review of dozens of randomized control trials have not found terb (or MgSO4) to be beneficial at stopping preterm labor, and because it poses a risk of causing serious maternal cardiac problems and death.

It's all in that link I posted above.

Okay. It did make my heart race and make me jittery, but we're both fine fortunately. Thanks!

We give it for hypersystole(too many contractions). We don't give it for tocolysis. T-Bird, the increased maternal heart rate is a pretty typical reaction.

For all of you whose hospitals no longer use Terb...do you mean that you no longer use it in the occasional subq to stop contractions or did you stop using it in other forms like on pumps/iv ?

I was given turb for preterm labor at 32 weeks. Unfortunately for me it almost killed me and my baby and my contractions still continued. Thankfully my nurse reacted quickly and I recovered. Not a big fan of the drug.

For all of you whose hospitals no longer use Terb...do you mean that you no longer use it in the occasional subq to stop contractions or did you stop using it in other forms like on pumps/iv ?

We stopped using it altogether for PTL. Like I said above, we will still very occasionally use it if the mother has tachysystole which is causing severe hypoxia in the fetus. We'll give one shot to slow contractions while we're also heading to the OR.