Preterm Labor Medication: Is Brethine Safe?

I am 21-weeks-pregnant and recently was prescribed Brethine to stop preterm labor. I read a few articles that said that Brethine is not FDA approved for this purpose, and that it should not be used for more than one week. Can you tell me more?

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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

Brethine or Terbutaline is used extensively in the treatment of preterm labor. It generally is initiated when preterm contractions cause cervical change. The physiology of its action is complex, but it is meant to quiet the uterine contractions. It is administered via IV in the hospital, then subcutaneously (injection) and finally orally at home or by infusion pump.

The reason that administration is associated with short term use (one week) is that the literature does not support better outcomes over the long term. But this medication can stave off labor until steroids can be administered which assist maturation of the baby's lungs.

Brethine is not FDA approved for use in preterm labor but the standard of care across the world accepts the use of this medication. In some women, it delays labor until 37 weeks, when the client stops taking it and goes into spontaneous labor. In some women, it seems to have little effect, especially in the presence of intrauterine infection.

Fetal side effects are primarily related to adverse maternal effects. Rapid heart rate in the mother is a common side effect which may cause accelerated fetal heart rate. In the worst case, this may lead to hypoxia and fetal distress. Mothers who receive this drug are initially hospitalized and monitored closely. There is a rare risk of maternal pulmonary edema, which, if left unchecked, can cause maternal and fetal death.

It seems quite early to begin medication at 21 weeks and it may be a good idea to seek a second opinion of an experienced obstetrician or perinatologist to see if this is an appropriate management plan for you.

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