Terbutaline (intravenous bolus) for the treatment of acute intrapartum fetal distress.

beta 2-Sympathomimetics have been used in acute intrapartum fetal distress to abolish uterine contractions and thus enable the fetal metabolism to recover before delivery. Because some serious complications were reported when a terbutaline intravenous bolus (0.25 mg) was used as a tocolytic, we assessed its safety and efficacy when used in patients not affected by cardiovascular disease, tachycardia greater than 100 beats/min, thyrotoxicosis, fluid overload, corticoids, atropine, or severe abruptio placentae. No maternal or fetal complications occurred in the 36 patients studied; a well-tolerated tachycardia developed in most patients. Fetal heart rate tracings and pH improved in 32 patients. Thirty-four neonates were delivered in good clinical and metabolic condition. We conclude that terbutaline intravenous bolus 0.25 mg is a safe and efficacious procedure when the proper indications and contraindications are followed.

Treatment of acute intrapartum fetal distress by beta 2-sympathomimetics.

Patients with a diagnosis of severe intrapartum fetal distress by fetal heart rate and capillary blood pH monitoring received beta 2-sympathomimetics to inhibit uterine contractions (tocolysis) while the obstetric team was preparing to deliver the fetus. Fetal heart rate and acidosis significantly improved after tocolysis; these fetuses were subsequently delivered in very good metabolic and clinical condition. The favorable effect of tocolysis on fetal homeostasis is attributed to the suppression of the ischemic effect of contractions on the placental circulation. The few fetuses having an extremely compromised placental function showed no improvement in heart rate or acidosis with tocolysis and were immediately delivered. Considering the mild side effects observed, the lack of maternal complications, and the remarkable perinatal outcome obtained, we recommend using tocolysis before delivering distressed fetuses.