Volume 153 Comparison of tocolytic drugs

Number 8

15. Boylan P, O'Driscoll K. Improvement in perinatal mor- of respiratory distress syndrome. Obstet Gynecol 1983;
tality rate attributed to spontaneous preterm labor with- 62:287.
out the use of tocolytic agents. AM 1 0BSTET GYNECOL 18. Pomerance11, Schifrin BS, MeredithJL. Womb rent. AM
1983;145:781. 1 0BSTET GYNECOL 1980;137:486.
16. Korenbrot CC, Aalto LH, Laros RK. The cost effective- 19. Cotton DB, Strassner HT, Hill LM, Schifrin BS, Paul RH.
ness of stopping preterm labor with beta-adrenergic treat- Comparison of magnesium sulfate, terbutaline and a pla-
ment. N Engl1 Med 1984;310:691. cebo for inhibition of preterm labor. J Reprod Med
17. Schutte MF, Treffers PE, Koppe 1G. Threatened pre- 1984;29:92.
term labor: the influence of time factors on the incidence

Single injection of terbutaline in term labor

I. Effect on fetal pH in cases with prolonged bradycardia

I. Ingemarsson, M.D., Ph.D., S. Arulkumaran, M.D., and S. S. Ratnam, M.D.

Lund, Sweden, and Singapore

Thirty-three patients with prolonged fetal bradycardia (fetal heart rate baseline <100 bpm for a minimum of
3 minutes or <80 bpm for at least 2 minutes) in labor were studied. They were treated with a bolus
injection of terbutaline if the bradycardia persisted at <80 bpm for 2 minutes and other efforts to improve
the fetal heart rate (oxygen, positional changes) had failed. After the bolus injection a scalp blood pH (or a
cord arterial pH in abdominal deliveries) was obtained within 30 minutes. Fetal acidosis was common if the
bradycardia lasted 10 minutes or more, particularly if the rate was <80 bpm with a flat baseline for 4
minutes or more. The fetal heart rate improved after injection in 30 cases; 23 patients had vaginal delivery
of infants in good condition. Ten underwent cesarean section: three for no improvement in fetal heart rate,
two for cord prolapse, four for later ominous fetal heart rate, and one for failure to progress. These results
suggest that tocolysis in selected cases can be of benefit for the fetus with prolonged bradycardia. In
cases with an ominous fetal heart rate pattern preceding the bradycardia and in abruptio placentae
immediate operative intervention without delay is probably better. Administration of terbutaline should be
regarded as a temporary measure until it is apparent that the fetal heart rate has recovered. Preparation
for emergency delivery should be made while a recovery is awaited. (AM J OssrET GvNECOL 1985;
153:859-65.)

Key words: Terbutaline, fetal pH, prolonged fetal bradycardia

Prolonged bradycardia in labor with a fetal heart rate activity, often induced by injudicious administration of
( FHR) baseline < 100 bpm in the first stage of labor is oxytocin, can be related to such FHR patterns. In the
often an innocuous finding as the FHR will usually modern management of labor, procedures such as vag-
recover spontaneously or after a shift in position of the inal examination, artificial rupture of the membranes,
parturient. In a few cases prolonged bradycardia may application of a scalp electrode, insertion of an intra-
be an indication of a serious complication such as cord uterine catheter, and paracervical or epidural anesthe-
prolapse, abruptio placentae, or severe fetal asphyxia, sia for pain relief may be associated with prolonged
especially if preceded by an ominous FHR pattern. Hy- bradycardia.
poxia of unknown origin or due to abnormal uterine These patterns give rise to much anxiety, particularly
if sustained after the usual corrective action, and lead
to emergency instrumental vaginal delivery or cesarean
From the Department of Obstetrics and Gynecology, University Hos- section, which may not be necessary and might be trau-
pital of Lund, and the University Department of Obstetrics and
Gynaecology, National University of Singapore, Kandang Kerbau matic to the mother or her fetus. In order to pre-
Hospital. vent unnecessary intervention, pharmacologic treat-
Received for publication june 7, 1985; revised October 1, 1985; ment with uterine relaxants has been tried. The drugs
accepted October 9, 1985.
Reprint requests: Dr. /. Ingemarsson, Department of Obstetrics and used are !3-adrenergic receptor agonists such as ter-
Gynecology, University Hospital, S-22185 Lund, Sweden. butaline,'·3 hexoprenaline,< and epinephrine6 or uter-

859
 860 lngemarsson, Arulkumaran, and Ratnam December 15, 1985
Am J Obstet Gynecol

Table I. Possible events related to the episode infusion, and another six had labor induced (all post-
of prolonged bradycardia (N = 33) term) by infusion of oxytocin and artificial rupture of
Event n the membranes. Oxytocin was given by an infusion
pump. Thirteen patients had an epidural block for pain
Abnormal uterine activity
Spontaneous 7
relief. A scalp electrode was used for recording the
Oxytocin-related 6 FHR. The uterine activity was recorded by an external
At vaginal examination I transducer in 18 patients and by an open-end intra-
At insertion of intrauterine catheter I
Abruptio placentae
uterine catheter in 15 patients.
2
Cord prolapse 2 Analysis of the fetal blood samples was done on In-
Booster dose of epidural block I ternational Laboratory Model 213 or 613 equipment
Suspected fetal distress preceding 4
bradycardia (ominous FHR and/or promptly after collection from the fetal scalp or from
thick meconium) a cord artery or vein after the cord had been clamped
Unknown 9 immediately after delivery. Maternal blood samples ob-
tained by a finger prick were analyzed at the same time
to exclude maternal acidosis. The mathematical mean
ine muscle relaxants such as magnesium sulfate. 5 The was used for calculation of mean pH values.
outcome of drug therapy in these case reports has usu- The FHR traces were interpreted in a manner de-
ally been measured by a recovering FHR and Apgar scribed earlier. 7 A prolonged bradycardia was defined
score at delivery and only occasionally by fetal scalp as a continuous baseline bradycardia < 100 bpm for a
blood pH measurements. The fetal acid-base balance minimum of 3 minutes and <80 bpm for at least 2
could give valuable information about the severity of minutes. A variability of the FHR of <3 bpm was con-
acidosis caused by the prolonged bradycardia and the sidered a flat baseline. A bolus injection of 250 f.Lg of
fetal capacity to recover from the acidosis after the terbutaline was given intravenously if the bradycardia
episode of bradycardia. In addition, the different char- persisted <80 bpm for at least 2 minutes and other
acteristics of the prolonged bradycardia could be cor- efforts to improve the FHR such as administration of
related with the fetal pH. oxygen and positional changes had failed. The oxytocin
The aim of the present study was to collect a consid- infusion was immediately stopped if patients were re-
erable number of cases with severe, prolonged brady- ceiving this drug, and a spontaneous recovery was
cardia of different origins and to study the fetal con- awaited for at least 4 minutes before terbutaline was
dition by evaluation of the fetal scalp blood pH within given. Scalp blood sampling was performed within 40
40 minutes of administration of a bolus injection of minutes of administration of the injection of terbuta-
terbutaline (250 f.Lg). Scalp pH samplings were repeated line; if the pH was ~7.24 the scalp pH measurement
if acidotic value were obtained; in cases of abdominal was repeated within 40 minutes. Cord arterial and ve-
delivery cord arterial and venous pH samplings were nous blood pH was measured in cases in which delivery
obtained instead. occurred shortly after the scalp pH sampling and in
those who had emergency cesarean section. In cases of
Patients and methods abdominal delivery propranolol, 1 to 2 mg intrave-
Thirty-three parturient patients with an episode of nously, was given to the mother after the cord was
prolonged bradycardia in labor were given 250 f.Lg of clamped in order to inhibit the relaxant effect of ter-
terbutaline sulfate as a bolus injection (intravenously) butaline and prevent uterine bleeding.'
at the University Hospital of Lund, Sweden, and the
University Department of Obstetrics and Gynaecology, Results
Kandang Kerbau Hospital, Singapore. The patients (24 The uterine activity was inhibited in all patients after
nulliparas, nine multiparas) were in term labor (37 ges- administration of terbutaline. In the 15 patients with
tational weeks or more) with the fetus in cephalic pre- intrauterine recording the uterine activity was totally
sentation. Seven were high-risk pregnancies: Six were abolished for a mean time of 14 minutes (range 7 to
postterm gestations (>42 weeks), and one had pro- 24). A similar degree of inhibition after terbutaline has
nounced polyhydramnios. Nine patients had compli- previously been reported."
cations at admission to the labor ward: Six had pre- Table I shows the possible factors related to the ep-
mature rupture of the membranes, two had an abnor- isode of prolonged bradycardia. Abnormal uterine ac-
mal FHR tracing immediately after admission, and tivity (rise of uterine pressure for more than 3 minutes)
one had vaginal bleeding with suspected abruptio was the most probable cause. Six of the 12 patients
placentae. receiving oxytocin infusion exhibited such activity at
Twenty-one patients had spontaneous labor with the time of bradycardia. Other factors were abruptio
normal progress, six had labor augmented by oxytocin placentae, cord prolapse, vaginal examination, or sus-
Volume 153 Terbutaline and prolonged bradycardia 861
Number 8

Fig. 1. Original recording of FHR (scalp electrode) and uterine activity (intrauterine catheter). Paper
speed of 1 em/min. The upper panel shows fetal bradycardia < 100 bpm for 5 minutes and <80 bpm
for 4 minutes with a flat baseline prior to injection of terbutaline (Bricanyl). Within 4 minutes of
the injection the FHR recovers. The lower panel shows the recovery period with fetal tachycardia
but no decelerations. Scalp blood pH was 7.18 (maternal pH 7.45) 20 minutes after the injection.
Scalp blood pH 30 minutes later had recovered to 7.28 (maternal pH 7.45).

Table II. Lag time, injection-recovery time, total duration of bradycardia, and mean scalp blood pH
within 40 minutes after episode of bradycardia according to different time intervals in patients with
recovery of FHR after injection of terbutaline (N = 28)
Cases according to lag time Cases according to injection-recovery Cases according to total duration (min) of
(from FHR <100 bpm time (from injection of terbutaline bradycardia (<100 bpm)
to injection of terbutaline) to FHR > 100 bpm)
Min (n) (n) n
I Mean scalp pH
2-3 14 23
4-6 12 4 19 7.32
7-9 2 1 5 7.29
10-14 0 0 4 7.22
Total 28 28 28

pected fetal distress. In one patient receiving an epi- ministration of terbutaline, the injection-recovery time,
dural anesthetic the bradycardia appeared 6 minutes that is, the time interval from the injection of terbu-
after a booster dose of bupivacaine (15 mg) was given taline to the point when the FHR had recovered (> 100
even though maternal hypotension was not recorded. bpm), and the total duration of the prolonged brady-
In nine cases no factor could be identified. cardia in relation to mean scalp blood pH. Half of the
Table II shows the lag time, that is, the time interval patients were given the bolus injection within 3 minutes
from the onset of bradycardia (<100 bpm) to the ad- of the onset of bradycardia: 12 after 4 to 6 minutes and
862 lngemarsson, Arulkumaran, and Ratnam December 15, 1985
Am J Obstet Gynecol

Table III. Scalp blood pH values within 40 minutes of episode of bradycardia in relation to duration of
bradycardia (minutes and a flat baseline of normal variability within bradycardia

Values

Flat baseline ?.4 min and FHR

<80 bpm (n = 4)
Scalp blood pH 7.16 (7.23, 7.26*) 7.18 (7.28) 7.22 (7.23) 7.27
Duration of bradycardia (min) 10 10 14 7
Flat baseline <4 min (n = 9)
Scalp blood pH 7.22 (7.22) 7.25 (7.29) 7.26 7.27 7.33 7.34 7.34 7.36 7.40
Duration of bradycardia (min) 6 5 7 7 6 5 6 6 6
Normal variability (n = 13)
Scalp blood pH 7.21 (a= 7.23) 7.31 7.32 7.32 7.32 7.32 7.34 7.34 7.34 7.34
(v = 7.30)
Duration of bradycardia (min) 4 4 4 4 7 10 5 5 5 6
a = Cord arterial pH. v = Cord venous pH.
*Repeated pH values within 40 minutes (scalp blood pH if not stated as cord arterial or venous).

Table IV. Data on the 10 cases delivered by cesarean section

Time from onset Cord blood pH Apgar score
Duration of of bradycardia
Indication for FHR to birth 1 ,, 5 !,10
No. Complication cesarean section* <80 (min) (min) Arterial' V enoU> mzn mzn mzn Remarks

FHR ominous at FHR not improved 8 20 7.10 7.19 7 8 9

admission
2 Polyhydramnios FHR not improved 10 25 6.98 7.02 6 8 Abruptio pia-
centae at
artificial rup-
ture of
membranes
3 FHR ominous 30 FHR not improved 13 25 7.04 7.ll 5 6 9
min after admission
4 Cord prolapse Cord prolapse 8 24 7.22 7.28 7 9 10
5 Cord prolapse Cord prolapse 6 19 7.12 7.24 9 9 10
6 Nothing of note FHR ominous later 4 30 7.14 7.19 9 10 lO Abruptio pia-
centae
7 Nothing of note FHR ominous later 3 240 7.20 7.24 5 8 9 Normal scalp
blood pH
8 Abnormal spontaneous FHR ominous later 5 160 NA NA 6 lO 10 Normal scalp
uterine activity blood pH
9 Premature rupture FHR ominous later 3 420 NA NA 9 9 10 Normal scalp
of membranes at term blood pH
Overstimulation
by oxytocin
infusion
10 Bradycardia at insertion No progress in labor 6 170 7.20 7.28 9 10 10 Normal scalp
of intrauterine blood pH
catheter

NA = Not assessed.
*In Cases 1 to 3 FHR did not improve after injection of terbutaline. In Cases 4 to 10 FHR recovered after injection.

two after 7 minutes. All patients receiving oxytocin in- A flat baseline within the bradycardia seemed to be
fusion had the injection after a lag time of more than an ominous sign if it lasted for 4 minutes or more (Table
4 minutes according to the protocol. The FHR recov- III). Of the four patients in this group two had a aci-
ered promptly within a period of 3 minutes in most dotic scalp blood pH, one a preacidotic value, and one
patients (23 of 28). The mean scalp blood pH was nor- a normal pH. Fig. 1 shows the recording of one of these
mal, 7.32 and 7.29, when the bradycardia lasted for 4 patients. She was a primigravid woman in spontaneous
to 6 minutes or 7 to 9 minutes, respectively. When the labor after an uneventful pregnancy. The intrauterine
bradycardia lasted for 10 minutes or more the mean pressure recording showed normal uterine activity.
scalp blood pH was preacidotic (7.22). The initial 4 minutes showed a flat baseline with brady-
Volume 153 Terbutaline and prolonged brady~rdia 863
Number 8

with the abnormal FHR patterns (Table I) makes ran-

domization difficult. An additional problem is to collect
a sufficient number of cases to allow a statistical analysis
Values Mean
with the stringent criteria for defining prolonged
bradycardia applied in the present study. It had also
been desirable to have a baseline scalp blood pH ob-
7.21
10.25 tained before the occurrence of the bradycardia but
that was not possible to obtain as the bradycardia
7.31 usually appeared without any preceding FHR changes.
6.0
However, the trend of the fetal pH after the episode
7.34 7.36 7.39 7.32 of bradycardia could be studied as the procedure was
repeated within 40 minutes in all cases with a low
6 6 9 5.8
pH (<7.25).
There is evidence, as shown by improvement of scalp
blood pH measurements, that administration of a ~­
cardia, which recovered within 4 minutes after terbu- adrenergic receptor agonist is of value in cases of fetal
taline administration. The scalp blood pH was acidotic distress with an ominous FHR pattern!· •·" This im-
(7.18) but recovered within 30 minutes (7.28). provement was shown to be significant when compared
A flat baseline lasting less than 4 minutes or a normal to that with placebo.' 2 Animal studies indicate that dur-
baseline variability within the period of bradycardia was ing hypoxia there is an endogenous increase of ~-ad­
associated with a low risk of fetal acidosis. However, renergic receptor activity that maintains the FHR and
this could be related to a shorter total time of brady- opposes the fetal bradycardia that may be caused by
cardia in these two groups (Table III). increased vagal activity induced by hypoxia. 13 ~-Adren­
Fig. 2 and Table IV show the outcome. In three pa- ergic receptor activity maintaining the FHR and con-
tients the FHR did not improve after an injection of sequently cardiac output through its inotropic action
terbutaline and remained <80 bpm. Two of these pa- and vasodilation of the placental vascular bed can keep
tients had an ominous tracing soon after admission that the umbilical blood flow at acceptable levels during
suggested a preexisting fetal hypoxia. The third pa- hypoxia' 3 and probably reduce the vascular resistance
tient, who had polyhydramnios, had abruptio placentae of the umbilical circuit. 14 A ~-adrenergic receptor ag-
at artificial rupture of membranes. All three had an onist administered in cases with bradycardia may en-
abdominal delivery within 25 minutes after the onset hance the potential beneficial effects described.
of bradycardia but the newborn infants were as- There were three failures in the cases discussed
phyxiated (cord arterial pH ~7.10). Cord prolapse oc- where obviously the factors above were not operative
curred in 2 patients (Nos. 4 and 5). After injection of (Fig. 2, Table IV). In two of the cases prolonged brady-
terbutaline the FHR improved immediately but cesar- cardia was demonstrated and there was thick meco-
ean section was performed without delay and the in- nium-stained liquor at admission that suggesteq a pre-
fants were in good condition at birth. The remaining ceding intrauterine asphyxia; the third had a major
28 patients had an initial FHR recovery after the ter- abruptio placentae. In such cases of advanced fetal as-
butaline injection and normal scalp blood pH values. phyxia it is possible that tocolytic agents may be of no
However, in six of these cases ominous FHR changes benefit and, in fact, could delay a necessary operative
appeared later in labor. Four were delivered by cesar- intervention.
ean section while the other two had vaginal deliveries. On the other hand, it is reasonable to believe that in
All infants were in good condition at birth. cases with abnormal uterine activity preceding the
Twenty-two of the 28 patients demonstrated no fur- bradycardia, tocolysis could be of benefit for the fetus.
ther signs of fetal distress after the episode of brady- Abnormal uterine activity interferes profoundly with
cardia and all but one (cesarean section because of ar- placental circulation and, if pronounced, could com-
rest of progress of labor) were delivered vaginally with promise the fetoplacental unit in an otherwise healthy
infants in good condition (Fig. 2). subject.' In cases with diminished placental reserve fetal
distress can develop in labor even with normal uterine
Comment activity.
A randomized design of this trial would have been ~-Adrenergic receptor agonists are potent inhibitors
preferable when evaluating the possible benefit of ter- of uterine activity when given as an intravenous bolus
butaline in cases with prolonged bradycardia in labor. injection. '· 3 • 15 In the present study the contractions were
However, the multivarious pattern of factors associated abolished for a mean of 14 minutes (range 7 to 24).
864 lngemarsson, Arulkumaran, and Ratnam December 15, 1985
Am J Obstet Gynecol

33

~
FHR improved FHR not improved
3

;:.,.,.. ,~
2 30

(cord I
cs
FHR remained normal FHR ominous later
6

21
VD
~ ~ 1
CS
2
VD
4
CS

FHR = Fetal heart rate

VD Vaginal delivery
CS Cesarean section

Fig. 2. FHR and mode of delivery after injection of terbutaline.

The FHR recovered (> 100 bpm) within 3 minutes in ministration of terbutaline should be regarded as a tem-
23 of 28 cases and within 4 to 6 minutes in four cases. porary measure until it is apparent that the FHR has
In only one case the injection-recovery time exceeded recovered to the previous baseline. Preparation for
6 minutes (Table II). Six of 15 patients with abnormal emergency delivery should be made while a recovery
uterine activity were receiving oxytocin infusion. In this is aw<:tited.
series we waited at least 4 minutes after stopping the
FIEFERENCES
oxytocin infusion for a spontaneous recovery before
administration of terbutaline. A delay of FHR recovery I. Anderson KE, Bengsson LP, Gustafson I, Ingemarsson I.
The relaxing effect of terbutaline on the human uterus
can be expected as the oxytocic action will remain for during term labor. AMJ 0BSTET GYNECOL 1975;121:620.
some time even after the oxytocin infusion is stopped. ' 5 2. Arias F. Intrauterine resuscitation with terbutaline: a
In such cases it might be beneficial to stop oxytocin method for the management of acute intrapartum fetal
distress. AMJ 0BSTET GYNECOL 1978;131:39.
infusion and give terbutaline. Relaxation of the uterus 3. Ingemarsson I. Use of 13-receptor agonists in obstetrics.
should also benefit the umbiljcal circulation in cases of Acta Obstet Gynecol Scand 1982;108(suppl):29.
cord prolapse by relieving any compression by the con- 4. Lipshitz J. Use of a 13-sympathomimetic drug as a tem-
porizing measure in the treatment of acute fetal distress.
tractions. AM J 0BSTET GYNECOL 1977;129:31.
Of the 33 patients in this series, FHR improved in 5. Reece EA, Chervenak FA, Romero R, Hobbins JC. Mag-
28 patients and in this group no emergency interven- nesium sulfate in the management of acute intrapartum
fetal distress. AMJ 0BSTET GYNECOL 1984;148:104.
tion was performed. Later six patients demonstrated 6. Wong R, Paul RH. Methergine-induced uterine tetany
recurrence of an ominous FHR pattern and four were treated with epinephrine: case report. AM J OBSTET GY-
delivered abdominally. Two thirds of our patients were NECOL 1979;134:602.
7. Ingemarsson E. Routine electronic fetal monitoring dur-
delivered vaginally. Except for the three cases with fail- ing labor. Acta Obstet Gynecol Scand 1981 ;99(suppl):6.
ure, all infants were in excellent condition at birth with 8. lngemarsson I, Westgren M, Lindberg C, Ahren B, Lund-
normal Apgar scores at 5 minutes. quist I, Carlsson C. Single injection of terbutaline in term
labor. Placental transfer and effects on maternal and fetal
These results suggest that tocolysis in selected cases carbohydrate metabolism. AM J 0BSTET GYNECOL 1981;
can be of benefit for the fetus with prolonged brady- 139:697.
cardia, particularly in cases with abnormal uterine ac- 9. Caldeyro-Barcia R, Magana JM, Castillo JB, eta!. A new
approach to the treatment of acute intrapartum fetal dis-
tivity, cord prolapse, or minimal fetoplacental reserve tress. In: Perinatal factors affecting human development.
or with bradycardia of unknown origin. However, in Washington DC: Pan-American Health Organization,
cases with an ominous FHR pattern preceding the 1979:185; Pan-American Health Organization Scientific
Publication.
bradycardia or abruptio placentae, immediate opera- 10. lngemarsson I. Terbutaline in obstetrics. Acta Pharmacol
tive intervention is probably better. If the bradycardia Toxicol 1979;44 (suppl)2:84.
lasts 10 minutes or more fetal acidosis may appear 11. Saling E. Fetal scalp blood analysis. J Perinat Med 1981;
9:165.
(Table II), particularly if the rate is <80 bpm with a 12. Gamissans 0, Carreras M, Duran P, eta!. The treatment
flat baseline for 4 minutes or more (Table III). Ad- of fetal acidosis with beta-mimetic drugs. Studies on acid
Volume 153 Terbutaline and prolonged bradycardia
Number 8

base balance, blood glucose levels and uterine motility. In: 14. Cohn HE, Piasechi GJ, Jackson BT. The effect of 13-ad-
Baumgarten A, Weselius de Casparis A, eds. Proceedings renergic stimulation on fetal cardiovascular function dur-
of an international symposium: the treatment of fetal ing hypoxemia. AMJ 0BSTET GYNECOL 1982;144:810.
risks. Vienna: University of Vienna, 1972:145. 15. Ingemarsson I, Arulkumaran S, Ratnam SS. Single injec-
13. Parer JT. The influence of 13-adrenergic activity on fetal tion of terbutaline in term labor. II. Effect on uterine
heart rate and the umbilical circulation during hypoxia activity. AM J 0BSTET GYNECOL 1985; 153:865.
in fetal sheep. AM j 0BSTET GYNECOL 1983;147:592.

Single injection of terbutaline in term labor

II. Effect on uterine activity

I. Ingemarsson, M.D., Ph.D., S. Arulkumaran, M.D., and S. S. Ratnam, M.D.

Lund, Sweden, and Singapore

The effect of terbutaline, 250 JJ-9 given as an intravenous bolus injection in term labor, was investigated
with use of a transducer-tipped catheter placed in the uterine cavity. Maternal side effects were common
but well tolerated. No fetal side effects were recorded. The results suggest that 250 ,..,g of terbutaline as a
bolus injection gives a safe and effective inhibition of uterine activity in term labor. Possible indications and
benefits of transient inhibition of uterine activity in term labor, particularly when fetal distress is associated
with abnormal uterine activity, are discussed. (AM J OBSTET GvNECOL 1985;153:865-9.)

Key words: Terbutaline, term labor, uterine activity

~-Mimetic drugs like terbutaline and ritodrine are The effect of this drug on the uterine activity has not
often used for inhibition of preterm labor. 1 After many been evaluated when given as a single injection. In this
years of use, the efficacy of these drugs in reducing study the effect of terbutaline, 250 f.Lg intravenously,
fetal morbidity and mortality is still debated. 2 The on spontaneous and oxytocin-augmented labor was in-
drugs, usually given as an infusion for several hours, vestigated by means of a transducer-tipped catheter
can give rise to severe complications, though rarely in placed in the uterine cavity. In a control group the
well-selected and monitored patients. 1 effect on uterine activity of stopping the oxytocin in-
Apart from preterm labor there are other situations fusion in augmented labor without giving terbutaline
in which inhibition of uterine activity is desirable, for simultaneously was studied.
example, abnormal uterine activity, fetal distress, pro-
longed fetal bradycardia, complicated cesarean sec- Patients and methods
tions, and transport of a laboring woman.' In such sit- Patients in spontaneous and augmented labor in the
uations inhibition is only necessary for a short period, University of Singapore unit labor ward at Kandang
and a bolus injection of a ~-mimetic drug might be Kerbau Hospital were recruited for the study. The aug-
sufficient. It is generally not associated with severe side mented labor group had oxytocin infusion for abnor-
effects, and consequently a controversy such as in the mal labor progress. The study was approved by the
case of the infusion therapy for preterm labor should local ethical committee. Informed consent for the study
not exist. Terbutaline, a selective ~ 2 -receptor agonist, was obtained from the patients.
has been used for this purpose.<·5a Patients with history of cardiac disease, hypertension,
diabetes, drug use, and thyrotoxicosis were not consid-
ered for the study. Cardiovascular and respiratory sys-
tems were clinically examined. Patients' height, weight,
From the Departments of Obstetrics and Gynecology, University Hos-
pital of Lund and National University of Singapore, Kandang and parity were noted. The pulse rate, blood pressure,
Kerbau Hospital. fetal heart rate, frequency and amplitude of uterine
Received for publication june 3, 1985; revised September 13, 1985; contractions, and uterine activity quantitated on line as
accepted September 23, 1985.
Reprint requests:/. Ingemarsson, Department of Obstetrics and Gy- the active contraction area above the basal pressure in
necology, University Hospital, S-22185 Lund, Sweden. kilopascal seconds every 15 minutes were recorded.

865