Clinical and Cost-Effectiveness of Continuous Subcutaneous Terbutaline Versus Oral Tocolytics for Treatment of Recurrent Preterm Labor in Twin Gestations

Abstract

Improved clinical outcomes and decreased nursery utilization suggest cost-effectiveness of outpatient continuous subcutaneous terbutaline versus oral tocolytics for the treatment of recurrent preterm labor.

The interval to spontaneous delivery following discontinuation of maintenance tocolysis

“…When administered orally, terbutaline's efficacy is often greatly influenced by poor patient compliance and the development of myometrial desensitization related to long-term, high-dose exposure [3]. Continuous subcutaneous terbutaline therapy (SQT) has been reported to be more effective than oral tocolytics for pregnancy prolongation following acute preterm labor in both singleton and multiple gestations [4][5][6], and is safe from serious side effects when used appropriately [7].…”

Does terbutaline damage the developing heart?

“…b 2 -Adrenoceptor (b 2 AR) agonists, notably terbutaline, are widely used as tocolytics to arrest preterm labor (Caritis et al, 1988;Guinn et al, 1998;Lam et al, 2001;Goldenberg, 2002). For terbutaline, this application is an ''off-label'' use only because the manufacturer has declined to apply for approval (Lam et al, 1998).…”

Uterine Contraction Monitoring, Maintenance Tocolysis, and Preterm Birth

“…(Morrison et al, 2001;Katz et al, 1986;Watson et al, 1990;Kosasa et al, 1990;Smith et al, 1994) Furthermore, after tocolysis of the second PTL episode or in pregnancies with advanced cervical dilation (>3-4cm), the combination of continued uterine contraction monitoring along with subcutaneous terbutaline infusion using a programmable pump have resulted in significantly prolonged gestation compared to no treatment or oral maintenance therapy. (Elliott et al, 2001;Morrison et al, 2003;Lam et al, 2001) Both contraction monitoring and terbutaline administration by subcutaneous pump, when used in appropriate patients, significantly increased the length of pregnancy, resulted in fewer low birth weight infants, and reduced neonatal stay as well as neonatal cost. Smith et al, 1994;Morrison et al, 2003;Lam et al, 2001) …”

“…(Elliott et al, 2001;Morrison et al, 2003;Lam et al, 2001) Both contraction monitoring and terbutaline administration by subcutaneous pump, when used in appropriate patients, significantly increased the length of pregnancy, resulted in fewer low birth weight infants, and reduced neonatal stay as well as neonatal cost. Smith et al, 1994;Morrison et al, 2003;Lam et al, 2001) …”