Ibuprofen vs. Terbutaline in Managing Preterm Labor: Which Is Safest?

At 30 weeks, I am experiencing preterm labor. My OB has advised the use of ibuprofen, rather than Terbutaline, to decrease the contractions and cramping. Which medication is the safest and has the fewest side effects on the fetus? Also, when would they consider giving steroids to increase lung development of the baby?

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

I am not very familiar with ibuprofen use in the treatment of preterm labor. We still use more Terbutaline in this location of the country. There are reports in the literature of its efficacy in the prevention of prematurity. It is a prostaglandin inhibitor, which is why it works. It may cause oligohydramnios (too little amniotic fluid), so its use is not recommended after 34 weeks. Theoretically, any non-steroidal anti-inflammatory drug (including ibuprofen and aspirin) may cause premature closure of the fetal ductus arteriosus (a fetal circulatory route). This has been reported -- but it is rare. One must look at the risk-benefit ratio. Surely, a baby born before lung maturity is at higher risk of difficulties.

Terbutaline has not been shown to cause any adverse fetal effects.

Steroids are administered in the case of preterm labor in order to mature the fetal lungs to prevent respiratory distress syndrome and intraventricular (brain) hemorrhage in the very small infant. In the U.S., we give Betamethasone (12 mg) by injection and repeat it in 24 hours. Optimal benefits begin 24 hours after initiation of therapy and last seven days, which is why women may receive weekly doses. The risk-benefit ratio of taking this drug is in your favor; no serious side effects have been shown to occur in the baby or mother.

I hope this answers some of your questions.

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