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terbutaline and magnesium sulphate

In addition to bedrest, doctors may prescribe various tocolytics, or drugs to prevent preterm labor. The purpose of this section is to present the experiences of other members of the twins list, not to provide medical information or advice. The Twins List FAQ on Terbutaline is available here.

Please remember that this is not medical advice!

I was on terbutaline pills every 4 hours around the clock for 5 weeks. I was allowed to stop at 36 weeks. I was convinced I would deliver immediatlely. I had to be induced a week later due to pre-eclampsia. Initially, I felt horribly shakey, like you would feel after a near miss in a car. I couldn't sleep the first night at all. Of course I was sent home from the hospital at 1AM. The side effects went away after about a day.

I was put on mag sulfate when they induced me so that I wouldn't have convulsions. I was really worried about this drug after hearing how horrible it was from other women on this list. I must say that for me it wasn't all that bad. I was hot, and it slowed down my contractions so that I had to be given pitocin, but other than that it wasn't too bad.

Magnesium Sulfate stopped my preterm labor both times, but it is rough. I jokingly called it the "Rubber Chicken Medicine" because it made me so limp. I quickly discovered where all of my long muscles were. After 2 days on Mag, I couldn't even spit out toothpaste when I brushed my teeth because my muscles were so relaxed. It made me so hot too. Everybody that walked into my hospital room said it was freezing and I couldn't even stand to have a sheet over my legs. But, it did keep me from delivering both times I was hospitalized with preterm labor so it was worth enduring. My boys were born at 34 weeks and now they're 9 months old and going everywhere around the house. It's worth enduring almost anything to have healthy babies.

Regular OB appointment. Extreme swelling in my legs, but no protein in my urine. My blood pressure was a nice, low 110/70. Based on the edema, OB had me begin a 24 hour protein/urine test and sent me to the lab to draw blood for kidney and liver functions. I had no headaches, blurry vision, or stars.

Late Wednesday:
Having lots of Braxton Hicks. I really didn't want to go to the hospital (I knew it wasn't 'real' labor) - but I knew it was too early for the boys to be born, so I went. Received two shots of terbutaline to stop contractions. OB ordered an additional set of bloodwork for kidney and liver function - which showed that I was starting to develop toxemia. Thursday morning at 6:30 a.m. I was admitted to the hospital, and shortly after that started on "the Mag Bag".

The initial dose was a 4 gram PUSH of Magnesium Sulfate. Based on this, I know now why Hell is described in Bible as a place of fire. During this 20 minutes of hellfire, I'm sure that the only reason I didn't melt away completely was that two nurses were holding on to me. Every fluid in my body that could escape was violently expelled. (Nurses do NOT get paid enough money!) I was sure I wasn't going to live, but I did. Then I was put on a continuous drip, which makes you feel like you've got the worst flu you've ever had in your life. Raging fevers are intermittently spaced with arctic chills, blurred vision, and skull splitting headaches.

After a day or so, they lowered the "mag bag" dose, and told me I was in the hospital until I delivered. They continued to monitor my liver, kidney and platelets with bloodtests around the clock. They also sent me for an amniocentesis to measure the maturity of the boys' lungs. The initial results were "immature", but the more sophisticated test indicated that they were mature.

Friday noon
My numbers took a turn for the worse, and the OB told me that he was inducing labor, and I had until Saturday morning to delivery the babies, or they would have to do a cesarean. He administered prostaglandin gel and a couple of hours later they started the Pitocin drip.
I found it extremely ironic that *I* - who had been on bedrest since 20 weeks to avoid preterm labor, was now being induced. But, I called my doulas, rallied my resources, and prepared myself to deliver these babies. I was sorry they were coming so soon, but very happy that their lungs were going to be OK.

For the rest of the story, see the Labor and Delivery FAQ.

I was put on bed rest at 27.5 weeks after I experienced some strong contractions. My cervix was a fingertip dilated and about 30 percent effaced. After home uterine monitoring revealed I was having too many contractions, I was put on 5 mg tablets of terbutaline at the hospital. I was supposed to take the terb every six hours. After a weekend on terbutaline, I called my OB and asked to be put on a lower dose. I was jittery, my heart was racing (pulse above 125) and my hands shook so badly I couldn't write.

My OB's solution was to put me on the terbutaline pump, which dispensed a smaller, more concentrated dose directly into my leg. A nurse arrived to show me how to operate the pump and change the site every four days. I had to stick myself with a needle each time I changed the site, which was unpleasant.

After the nurse left, my contractions were too high and my legs shook uncontrollably from the terbutaline all night. But I was up monitoring anyway because of the contractions. Finally in the morning, they settled down.

I spent five weeks on bed rest and the terb pump. I was still jittery and could not do things requiring fine motor control (ie. writing) unless it was right before a bolus (larger dose) from the pump. I became breathless toward the end of my five weeks on the terbutaline. One of the monitoring nurses kept on asking me if I was having trouble breathing. I thought it was the ever-growing babies. Now I'm not so sure.

I was put magnesium sulfate in the hospital in a last-ditch effort to stop my contractions. I had made it to almost 33 weeks and was also on the terbutaline pump. The nurses kept on turning up the dose until I was at the highest level. My hands, face and feet felt like they were on fire. I felt groggy and uncoordinated and slow. I spent the night with a compress on my face. Because I was hooked up to an IV, I couldn't get out of bed and had to use a bedpan. I couldn't eat solid food because they were afraid the mag sulfate would make me throw up. I also couldn't drink anything -- just ice chips. My lips were dry and cracked by morning. I was still having contractions, although not as many. I started to get double vision. Blood tests revealed abnormal kidney and liver readings.

When the doctors told me I had pre-eclampsia and they would have to take the babies, I was so relieved and *glad* the torture was over. I was taken off all the drugs, and had an emergency C-Section later that day when one baby developed signs of distress. I developed spiking blood pressure after my daughters were born.

After my release from the hospital, I discovered I couldn't breath well lying down. After three sleepless nights and calls to my OB's office (she was on vacation), an echocardiogram was ordered. It showed the left ventricle of my heart was enlarged and not pumping efficiently (dilated cardiomyopathy). After doing some research, my cardiologist thinks this heart problem was caused by the terbutaline I took and/or my pre-eclampsia. He doesn't know which. We held off on the heart drugs since my pre-eclampsia was subsiding. About 7 months later, a repeat echo showed my heart is almost back to normal.

Since then, my new OB has told me that "it's common knowledge in medical literature" that combining preterm labor drugs such as terbutaline and magnesium sulfate can cause heart problems. I found some studies that support his assertion.

I did some research on terbutaline at a medical library and on the Internet. I found reports going back to at least 1981 of heart and lung complications in women taking terbutaline for preterm labor. Terbutaline is an asthma drug that has never been approved by the FDA for use as a preterm labor drug. I've also found studies published in 1996 and 1997 that show that terbutaline doesn't work any better than a placebo in prolonging pregnancies after a 48-hour dose in the hospital. These were double-blind, randomized studies.

I would recommend to all women experiencing preterm labor that they educate themselves about the risks of terbutaline and other preterm labor drugs. If you do choose to take preterm labor drugs, insist upon being monitored closely for heart and lung complications. Try to avoid being put on more than one drug at a time.

Please note: I'm not a doctor, nor am I medically trained.

I've also done some research, and found several studies (also randomized, double blind) which do show that terbutaline is quite effective. Even one of the more negative studies, which did not find an overall improvement, found that terb was more effective than the placebo when treatment started before 32 weeks (when the baby(ies) are most at risk).... I've also seen substantial anecdotal evidence during my nearly 4 years as an amature expert of twins showing a clear link between use of Terbutaline and prevention of preterm labor.

There have been a lot of reports recently about the risks and side effects of terbutaline for preterm labor, and I can only imagine how these reports would have worried me four years ago when I was put on the terbutaline pump for preterm labor at 30 weeks. I am not a medical professional, so my story should not be construed at advice to anyone considering tocolytics, but I wanted to share our experience and feelings about tocolytics with anyone grappling with this issue at this point.

After my OBs prescribed terbutaline, I was very carefully monitored. In addition to my weekly OB appts, a nurse came to my house once a week to check blood pressure, blood sugar, heart, urine, and a number of other parameters. In addition, each night when I called in for my electronic monitoring session, I had to take my pulse. Any time I had to administer extra doses (or bolus') of the terbutaline because I was having too many contractions, I was required to get my resting pulse before the dose was given and then again later. Although not aware of the studies now coming out, I was aware that terbutaline was a drug to be used carefully for a very specific purpose. And my doctors, who were very experienced with high-risk pregancies and multiple pregnancies, watched my health very carefully. They also sent me to a perinatologist three times during the pregnancy to more carefully monitor the health of the babies.

I thank my doctors for their conservative approach to my pregnancy. They ordered an electronic monitor at 20 weeks because of my reports about frequent contractions early on, and my insurance co agreed to pay for it. Today that might be harder because some studies are showing that the monitors might not be any better than a weekly discussion with a nurse in preventing preterm labor. I would have been one of the grim statistics in that study, because my labor was picked up by the electronic monitor in the form of contractions I didn't even feel. I had been having SO many contractions since 18 weeks or so, that did not cause any thinning or dilating of my cervix, that when they increased to one every three minutes during the hour of my evening monitoring session, I was still only feeling about 5 in an hour - I wasn't supposed to call in unless I felt more than 6. Thanks to the monitor I was sent to the hospital where we found that I was contracting every 3 minutes. Because we caught it so soon (thanks again to the monitor) my cervix had only thinned a little and dilation was only fingertip. I was sent home with a terbutaline pump and a nurse came to my house to teach me how to use it. Had I developed any cardiac complications during this time I would not have suspected a link with terbutaline, because I already knew I had a heart murmur and suspected mitral valve prolapse. Interestingly, no one had been able to hear my heart murmur since childhood -- until my first exam after I got pregnant. So the murmur was there long before terbutaline became an issue for me. I wonder, though, whether I was followed as carefully as I was *because* my doctor's knew of my history. Maybe this conservative care wasn't the norm......

I did have three very rough days on the terbutaline until I got used to it. I was too winded to talk on the phone, even while lying down, and my heart raced constantly. I was asked to check my pulse frequently, and had it gotten going too high (can't remember what was allowed) I would have been put in the hospital. It did even out after a few days and I felt much better. I had felt so bad before the medication that it was tough to say what was caused by medication and what was due to that pound I put on over the past three days (you've heard of the 'straw that broke the camel's back?' I was waiting for that 'pound that pushed the pregnosaurus over the precipice'). Five weeks later, after an ultrasound showing big, well developed babies, I was taken off the pump. My last dose was at noon on a Thursday, at 35.5 weeks gestation. One of my doctors watched me waddle (actually, that word sounds too fast and graceful for what I was capable of at that point!) out the door and said "glad I'm not on call this weekend because you're going to keep somebody up all night!" Sure enough, at 10pm I suspected labor was beginning. At four am Fri. there was no question, and, after a dose of pitocin at 5pm to speed things up, we kept the other doctor up all night to deliver our miracles at 6:01 and 6:03 am Saturday morning. At 7.5 and 6 lbs, they were ready to go home before I was!

I might have been a bit more prepared for medical intervention than many, because our twins were conceived with Perganol, Metrodin, and HCG and I took progesterone for three months to maintain my uterine lining. Because of new reports at that time (1993) about a possible link between ovarian cancer and fertility drugs, we had already had to weigh the risks and benefits of medications. In reading the studies I noted that the authors suggested that it was possible that infertility might have been a symptom of a condition which predisposed these women to ovarian cancer, rather than a result of the fertility medications they took. We decided to go ahead with the treatment, with the idea that if we heard later this link was verified, I would be especially careful monitoring my ovaries, just as I already am with breast cancer monitoring (due to family history). My desire to be a parent outweighed the risks, which I thought might be overstated anyway, AND I felt that I just might have to take steps later to protect myself (yearly ultrasounds, etc) if the link ended up being a real one. Incidentally, last that I heard the statistics were pointing to the fact that it was the women who did NOT become pregnant on fertility drugs who later developed ovarian cancer. Therefore it seems (haven't read the current studies, so don't quote me!) that it was in fact another condition altogether. I do know several people who elected not to pursue medical treatment because of these studies, and, when I look at my two little miracles, I am now so glad I was not one of them.

This is the way I felt about the terbutaline, too. I was aware that there were some risks associated with the medication, but I was even more aware of the risks of NOT taking it. When we found out we were having twins, we read the pamphlets on tocolytics and the signs of preterm labor. We also visited an NICU. It's not like I'm looking for trouble, but just wanted to be prepared ahead of time for whatever came up. What I saw in the NICU was both wonderful and sad. I was ready to deal with preterm birth if it had to happen, but if there was some way for me to prevent it, or to get the babies closer to term than they would be without intervention, I had to do it. To me, monitoring the mother closely during tocolytic treatment to watch for some very rare side effects seems a small price to pay to avoid the medical problems that very premature babies cannot escape.

So, to those of you trying to decide how you feel about tocolytics, talk to your doctor, and get a second or third opinion if you don't feel comfortable. You might also want to visit the NICU if you are at risk for pre-term birth. This was suggested to us by friends who delivered a 2 lbs baby 11 years ago (who, by the way, is a wonderfully normal 11 year old). They were terrified when they first hit the NICU, and feel that the first few days would have been alot easier had they been prepared for and understood what all the equipment was for. This family, by the way, had a similar risk/benefit decision to make, since the steroid injections for lung maturity were experimental at the time. They had time for two days of injections, which they credit with keeping their two pound baby from having any respiratory difficulties after birth. Now this treatment is used every day........

Editor's note: If you'd like to know more about this issue, see

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