Will you give terbutaline to vaginal bleeding pt?

MassED, BSN, RN · Apr 16, 2010

Hello,
Will you give terbutaline to lady partsl bleeding pt? One of my pts was G4P2, 34 weeks GA, had intermittent lady partsl bleeding. Ultrasound showed that she had placenta previa. Because she had contractions q 3 minutes, MD ordered Terbutaline 0.25 mg sq. Before I gave the terbutaline, one of my coworkers remind me that Terbutaline is contraindicated in lady partsl bleeding pt. I realized that because one of side effects of Terbutaline is Tachycardia, Terbutaline might mimic the s/s of active bleeding. I then held the Terbutaline and called the MD again. He ordered to not give at that time, but later he still blamed me for not giving pt at least one dose. I tried to find any document which can prove that Terb is contraindicated in lady partsl bleeding pt, but no findings. I am wondering if you know anything about that. What will you do in that kind of situations? Thanks.

I'm not OB/GYN, but found this link

http://www.pregnancytoday.com/articles/premature-births/talking-terbutaline-4545/

I did not know Terbutaline was used to stop preterm labor. That article also notes "there are controversial studies showing that the drug may be associated with an increased risk of brain hemorrhage in the preemie, one of the potential complications of prematurity anyway."

It points out that there are lack of controlled studies w/ the use of Terbutaline. It goes on to say it can be potentially dangerous!! Good thing you guys called the doc and he/she decided against it.

I didn't read anything about it being contraindicated w/ bleeding - only side effects "may include jitteriness, increased heart rate, tremors, headaches, dizziness and, very rarely, increased blood sugar and seizures" - which seem problematic in and of itself. There is an OB in the article that has used it for years.... nothing about contraindications, though... but thanks for teaching me something about Terbutaline and researching that a bit!

added another source: http://www.drugs.com/pro/terbutaline.html

Use in Labor and Delivery

"Because of the potential for beta-agonist interference with uterine contractility, use of Terbutaline Sulfate Injection, USP for relief of bronchospasm during labor should be restricted to those patients in whom the benefits clearly outweigh the risk. Terbutaline crosses the placenta. After single dose IV administration of Terbutaline to 22 women in late pregnancy who were delivered by elective Cesarean section due to clinical reasons, umbilical blood levels of Terbutaline were found to range from 11% to 48% of the maternal blood levels."

CEG · Apr 17, 2010

Hello,
Will you give terbutaline to lady partsl bleeding pt? One of my pts was G4P2, 34 weeks GA, had intermittent lady partsl bleeding. Ultrasound showed that she had placenta previa. Because she had contractions q 3 minutes, MD ordered Terbutaline 0.25 mg sq. Before I gave the terbutaline, one of my coworkers remind me that Terbutaline is contraindicated in lady partsl bleeding pt. I realized that because one of side effects of Terbutaline is Tachycardia, Terbutaline might mimic the s/s of active bleeding. I then held the Terbutaline and called the MD again. He ordered to not give at that time, but later he still blamed me for not giving pt at least one dose. I tried to find any document which can prove that Terb is contraindicated in lady partsl bleeding pt, but no findings. I am wondering if you know anything about that. What will you do in that kind of situations? Thanks.

I have never heard of not giving terb to pts with lady partsl bleeding. But in any case I am not sure why the doctor would "blame" you. He gave you an order to hold the med. Does he want you to give meds even when he tells you to hold them? Or did he not know the side effects of terb and just took your word for it and now is mad?

Either way, if he wants to play the blame game he should be looking in the mirror. Obviously you should be sure to have evidence-based guidance for your practice, but as the doctor he is responsible for the orders given and followed for the patient.

MassEd almost all drugs used commonly in Ob/Gyn say scary things about potential side effects, it's due to the lack of study and the desire of the drug companies to cover themselves liability-wise. Terb is very widely used in OB and has been for a long time.

jctiabecerra · Apr 17, 2010

i also have never heard of not giving terb to vag bleederws.

klone, MSN, RN · Apr 17, 2010

Terb can cause uterine atony (obviously, if it's used for PTL). If we have a patient who is in active labor but d/t fetal distress, must go back for an emergent C/S, we will give ONE dose of Terb to stop/slow down UCs, but the docs generally do not want more than one dose, d/t the risk of PPH after the C/S.

cnm in progress · Apr 17, 2010

Terbutaline is a very common tocolytic in OB. Consider the risk vs. benefit... in this case there is a known placenta previa. Continued contractions will lead to dilation which can lead to fetal death. Giving terb will quiet the uterus and potentially stop preterm labor, at least long enough to get her into the OR for a c-section. In a case of lady partsl bleeding of unknown origin, I would hold off on giving it.

Jiayou · Apr 18, 2010

Thank you all for your posts. They are very informative. I appreciate that. Especially thank you cnm in progress and Klone for your opinions from different points of view. I have learned a lot. I will consider more the risk vs. benefit next time when I make my decisions. Thanks.

Jiayou · Apr 18, 2010

Hello everyone,

I finally found the evidence! In the AWHONH book, in the chapter, " Guideline for the Management of pts with Diagnosed or suspected placenta previa during the peripartum period," it says "Beta - agonist (Ritodrine, Terbutaline) are contraindicated in the presence of active bleeding" ( "High-risk & critical care Intrapartum Nursing" written by Lisa K. Mandeville and NAn H. Troiano, pg 428).