Uses of Terbutaline in Obstetric Patients
Terbutaline should NOT be used for tocolysis (prevention of preterm labor) due to serious maternal risks including death, cardiac arrhythmias, pulmonary edema, and myocardial ischemia, as explicitly warned by the FDA. 1
Primary Uses in Obstetrics
1. Uterine Relaxation for Retained Placenta
- Terbutaline may be used as an alternative to nitroglycerin for uterine relaxation during removal of retained placental tissue 2
- Administered in incremental intravenous doses to achieve sufficient uterine relaxation while minimizing potential complications
2. Management of Acute Uterine Hypercontractility
- Can be used for transient inhibition of uterine activity in term labor when fetal distress is associated with abnormal uterine activity 3
- Typically administered as a 250 microgram intravenous bolus injection for safe and effective inhibition of uterine activity
3. Asthma Management in Pregnant Patients
- Classified as a short-acting β2-agonist (SABA) that can be used during pregnancy for asthma management 2
- Considered "probably safe" during second and third trimesters according to the European Respiratory Society guidelines
Safety Concerns and Contraindications
FDA Warnings
- Not FDA-approved for acute or maintenance tocolysis 1
- Serious adverse reactions reported in pregnant women include:
- Death
- Cardiac arrhythmias
- Pulmonary edema
- Myocardial ischemia
- Maternal hyperglycemia
- Hypokalemia
Fetal/Neonatal Risks
- Increased fetal heart rate 1
- Neonatal hypoglycemia 1
- Potential for β2-agonist interference with uterine contractility during labor 1
Administration Considerations
Dosing
- For uterine relaxation: Incremental IV doses titrated to effect
- For asthma management: Standard dosing as with non-pregnant patients
- For acute uterine hypercontractility: 250 micrograms IV bolus
Monitoring Requirements
- Continuous maternal cardiac monitoring
- Blood glucose monitoring
- Potassium level monitoring
- Fetal heart rate monitoring
Historical Context
While terbutaline was previously widely used for tocolysis 4, with studies showing success rates of 80-83% in delaying delivery for at least 48 hours 5, 6, current evidence and FDA warnings strongly advise against this practice due to serious maternal and fetal risks.
Common Side Effects
- Maternal tachycardia (most common, reported in up to 95% of cases) 5
- Tremor
- Nausea
- Dizziness
- Hyperglycemia
- Hypokalemia
Clinical Decision Making
When considering terbutaline use in obstetric patients:
- Evaluate if the indication is for uterine relaxation for retained placenta or acute uterine hypercontractility
- Confirm absence of contraindications (cardiac disease, uncontrolled hypertension)
- Use lowest effective dose for shortest duration possible
- Implement appropriate maternal and fetal monitoring
- For asthma management, consider as part of standard treatment approach when benefits outweigh risks
Remember that for tocolysis, the American College of Obstetricians and Gynecologists recommends nifedipine, indomethacin, and magnesium sulfate as first-line options instead of terbutaline 7.