Re: Terbutaline Pump

[Guest guest]

In a message dated 10/26/99 9:39:16 AM Eastern Daylight Time,

TEACHNRN@... writes:

<< Celestone has been given to the 31 week twins and I can't even imagine her

having to stay on mag therapy!

I would appreciate it if you could point me towards some of those studies.

I'd like to read them. >>

Well first of all, lets clarify that these Mom's do NOT have to STAY on mag

therapy. They are typically on tocolysis for at least 24 hours, (long enough

to get steroids on board and ctx halted most of the time, then therapy is

stopped.)

Now on to the info you requested.

Here is a partial list of some of the journal articles, standards, research

etc that we have used in our Nurse Practice Committee for Preterm labor.

Some of these are pro terb, some are not, most are the current trends in mgmt

of preterm labor with their associated rationale.

For the group.....

Have any of the rest of you out there been doing anything with risk

assessment such as Salivary Estriol Tests aka spit test, or SALEST????

How about Fetal Fibronectin testing???? Anyone using atosiban? How about

Keterolac - not for pain mgmt I mean as a prostin inhibitor????

I would love to hear about your use of these, sometimes when you are out in

the boonies, you forget what the rest of the world is also working on. We do

so many " new " things that alot of people havn't even heard of. Come on,

speak up if you have!

Anyway, here are the suggested readings.

ACOG Preterm Labor. Technical Bulletin #206. Washington, D.C. ACOG 1995

ACOG Fetal Fibronectin Preterm Labor Risk Test. Committee Opinion #187.

Washington, DC ACOG, 1997.

ACOG. Home Uterine Activity Monitoring. Committee Opinion #172. Washington DC

ACOG 1996 (Intersting conclusion about home uterine activity monitoring

stating there is more data needed to establish the benefit of HUAM, multiple

gestation only subgroup in which a slight benefit was shown, not generally

recommended)

Allbert JR, Wise CA, Lou CH, etal. Subcutaneous tocolytic infusion therapy

for patients at very high risk for preterm birth. J of Perinatology

12(1):28-31, 1992

Baird SM (ed) Guidelines for the management of patients with preterm labor

requiring tocolytic therapy. In LK Mandeville and NH Troiano (Eds) AWHONN's

High Risk & Critical Care Intrapartum Nursing (2nd Ed.). Philidelphia:

Lippincott. pp. 423 - 426. 1999.

Bossmar T, Akerlund M, Fantoni G, et al. Receptors for and myometrial

responses to oxytocin and vasopressin in preterm and term human pregnancy;

effects of the oxytocin antagonist atosiban. Am J Obstet Gynecol 171 (6):

1634 - 1642, 1994. (good article about the use of atosiban - an oxytocin

antagonist)

Brown HL, Britton KA, Brizendine EJ, et al. A randomized comparison of home

activity monitoring int he outpatient management of women treated for preterm

labor. Am J Obstet Gynecol, 180(4):798 - 805, 1999.

Childless CH, Katz VL. Nifedipine and its indications in obstetrics and

gynecology. Obstet Gynecol, 83(4):616. 1993.

Creasy RK. Preterm birth prevention: where are we? Am J Onstet Gynecol.

168(4): 1223 - 1230, 1998.

Dunn PA, Feinberg RF. Oncofetal fibronectin: new insight into the physiology

of implantation and labor. JOGNN, 25(9): 753-757, 1996.

Fangman JJ, Mark PM, Pratt L. etal. prematurity prevention programs: an

analysis of successess and failures. Am J Obstet Gynecol. 170(3): 744, 1994.

Guinn DA, Goepfert AR, Owen J, et al. Management options in women with

preterm uterine contractions: a randomized clinical trial. Am J Obstet

Gynecol, 177(4): 814 - 919, 1997.

Goodwin TM, Millar L, North L. The pharmokokenetics of the oxytocin

antagonists atosiban in regnant women with preterm uterine contractions. Am J

Obstet Gynecol. 173(3 pt 1):913- 917, 1995.

Goodwin TM, Valwnzuela G, Silver H, et al. Treatment of preterm labor with

the oxytocin antagonist atosiban. Am J Perinatology, 13(3):143 - 146, 1996.

FDA. Use of approved drugs for unlabeled indications. FDA Bulletin, 12:4,

1982.

Goldenberg RL, Mercer BM, lams JD, et al. The preterm prediction study:

patterns of cervicovaginal fetal fibronectin as predictors of spontaneous

preterm delivery. Am J Obstet Gynecol., 177(1):8-12, 1997.

Iams JD, Casal D, McGregor JA, et al. Fetal fibronectin improves the accuracy

of diagnosis of preterm labor. Am J Obstet Gynecol, 173(1):141 - 145, 1995.

DP, BA. Teh nursing management of women experiencing pretem

labor: clinical guidelines and why they are needed. JOGNN, 25(7): 569 - 592,

1996.

Keirse MJ. New persepctives for the effective treatment of rpeterm labor. Am

J Onstet Gynecol. 173(2): 618 -628, 1995.

Lam F, Elliott J, JS, et al. Clinical issues surrounding the use of

terbutaline sulfate for preterm labor. Obstet Gynecol Survey, 53(11): S85 -

S95, 1998.

R, Mercer BM, Salama M, et al. Oral terbutaline after perenteral

tocolysis: a randomized, double blind, placewbo-contolled trial. Am J Obstet

Gynecol. 175(4 pt 1):834 - 837, 1996.

DF, Bergstedt S, MS, et al. Successful magnesium sulfate

tocolysis : is " weaning " the drug necessary? Am J Obstet Gynecol 177(4):

742-745, 1997.

Lockwood, CJ, Wein R, Lainski R. et al. The presence of cervical and vaginal

fetal fibronectin predicts preterm delivery in an inner city onstetric

population. Am J Obstet Gynecol, 169(4): 798-804, 1993.

Macones GA, CA. Is there justification for using indomethacin in

preterm labor? An analysis of neonatl risks and benfits. Am J Obstet Gynecol.,

177(4) 819 - 824, 1997.

KB, Grether J. Can magnesium sulfate reduce the risk of cerebral

palsy in very low birth weight infants? Pediatrics, 95: 263 - 269, 1995 (Very

interesting stuff about mag decreasing this risk).

Niebyl JR, Witter FR. Neonatal outcvome after indomethacin treatment for

preterm labor. Am J Obstet Gyenecol, 55:747 - 749, 1986 (I think this is the

one about the premature ductus closing???)

National Institute of Health. Report on the consensus development conference

on the effects of corticosteroids for fetal maturation on perinatal outcomes.

Bethesda, MD. National Institute of Child Health and Human Development, 1994.

Thats a few, enjoy!!!

Teehee

Jan

[Guest guest]

I totally agree with you. We rarely use the pump, in fact I can't remember

the last time that we did. We've had this discussion at work recently and

agree with what you are saying. Many of us who had their babies before the

prevalent use of Terb, would have been diagnosed with PTL!

It's too bad that we don't take into account what all this does for the

woman's psyche and her home life.

RNC

So.Cal.

> And since I dont even want to get into the terb battle AGAIN on this

loop,

> --- I have been totally outnumbered before in my side of the battle (that

> terb is NOT effective as a long term tocolytic and has WAY too many nasty

> side effects and is WAY overused without sufficient long term research,

and

> often used to treat preterm contractions that do not meet the diagosis of

> preterm labor...geez but I'm not judgemental eh?)