Three-arm study—15 terbutaline pump, 15 oral terbutaline, and 12 saline pump. Significant methodological flaw in those patients crossed over between groups while in study. Patients on oral terbutaline or saline pump were switched to terbutaline pump if therapy failed. No electronic contraction monitoring or daily nursing contact. Tocolytic therapy was not individualized for each patient. Study underpowered in that it did not contain enough patients to show a difference between groups. No difference in outcomes between groups.
Overall dropout rate 38%. 13 patients in the terbutaline group completed this study and 19 patients in the placebo group. Advanced median cervical dilatation of 3 cm, effacement of 50% at start. Tocolytic therapy was not individualized for each patient. No electronic contraction monitoring or daily nursing contact. Study was underpowered and, therefore, showed no difference in outcomes between groups.
Extremely low incidence of serious adverse events. GAD was 36.6 weeks in the singletons, 34.9 weeks in the twins, and 32.8 weeks in the triplets. Authors conclude that therapy is a viable and safe option for outpatient management.
A comprehensive clinical pathway (CCP) including subcutaneous terbutaline proved significantly better outcomes (35.1 ± 1.6 versus 31.6 ± 3.1 weeks GAD) compared to concurrent local standard of care. Of the 12 patients whose GAD was <32 weeks, 1 received the CCP including subcutaneous terbutaline, compared to 11 who received the concurrent local standard of care.
Among patients with recurrent PTL, the use of SQT infusion significantly prolongs pregnancy while decreasing the likelihood of the rate of low birth weight (2500 g) infants, the need for admission to NICU, and duration of being hospitalized. For every dollar spent on SQT, there was a saving of $4.67 on the charges of newborns stay in the hospital.
Twin pregnancies discharged for outpatient management following i.v. treatment for PTL obtained significantly longer pregnancy prolongation, a greater gestational age at delivery, and delivered infants with fewer NICU admission.
Medicaid versus commercial patients with singleton gestations and cervical dilatation of ≥2 cm at PTL. Medicaid patients experienced comparable pregnancy prolongation and gestational age at delivery as commercially insured. 96% of medicaid patients experienced pregnancy prolongation of at least 7 days after PTL. Incidence of discontinuation of SQT for noncompliance was 1.6% for medicaid versus 2.8% for commercially insured ().
Twin pregnancies with PTL. Medicaid versus commercially insured. Similar pregnancy prolongation and GA at delivery. 97% of medicaid patients experienced >7 days of pregnancy prolongation after PTL. Incidence of discontinuation of SQT for noncompliance was 4.6% for medicaid versus 2.0% for commercially insured ().
Singleton gestations hospitalized with CPTL; all treated with SQT following stabilization. The degree of cervical dilatation and gestational age at initiation of treatment are predictive of subsequent pregnancy outcome. With each centimeter of cervical dilatation, the risk for delivery at <32 weeks almost doubles.
Singleton gestations with elective discontinuation of tocolytic treatment that occurred at 33–36 weeks’ gestation were found to have a higher incidence of late preterm birth, with significantly greater rates of NICU admission and low birth weight, and significantly higher nursery charges. Tocolytic treatment should be continued through 36 weeks.
In twin pregnancies receiving nifedipine tocolysis, alteration of tocolytic treatment to subcutaneous terbutaline following hospitalization for recurrent preterm labor symptoms had a positive impact on pregnancy prolongation and neonatal outcomes.
Alteration of tocolytic treatment following rehospitalization for PTL resulted in decreased antepartum hospital days, decreased nursery days and lower rates of higher level nursery admission and preterm birth, proving both to be clinical and cost effective.