Terbutaline

SAN FRANCISCO - Using continuous subcutaneous terbutaline instead of oral tocolytics for recurrent preterm labor yields better outcomes and is far more cost effective, Dr. Fung Lam reported at the annual meeting of the American College of Obstetricians and Gynecologists.

In a matched-cohort comparison, 558 pregnant women with singletons received home care for recurrent preterm labor at approximately 32 weeks' gestation. All had been treated with oral tocolytics for initial preterm labor at a mean of 28 weeks' gestation.

Half the women (279) received continuous subcutaneous terbutaline for the recurrent preterm labor, and the other half were treated with oral tocolysis--oral terbutaline in 95%; nifedipine, magnesium, gluconate, or indocin in 5%; and multiple tocolytic agents in 32%, explained Dr. Lam and associates of California Pacific Medical Center in San Francisco.

Gestational age reached at least 36 weeks in 71% of women on subcutaneous terbutaline and 57% of patients on oral tocolytics.

Forty-seven percent in the subcutaneous terbutaline group reached 37 weeks' gestation, compared with 39% in the oral tocolysis group. Women treated with subcutaneous terbutaline gained 6 days more in gestational age than did women on oral tocolytics, for a mean total gain of 34 vs. 28 days, respectively.

Fewer babies were born weighing less than 2,500 g in the subcutaneous terbutaline group (21%), compared with the oral tocolysis group (38%)--a clinical difference that saved big bucks due to shorter antepartum hospitalizations, fewer nursery days, and less use of the neonatal ICU (NICU) in the subcutaneous terbutaline group, the investigators said.

Mean nursery days totaled 5 in the subcutaneous terbutaline group and 9 in women given oral tocolytics. NICU admission rates were 19% following subcutaneous terbutaline and 26% with oral tocolysis, Dr. Lam said.

Estimated outpatient charges per patient were higher with subcutaneous terbutaline treatment ($5,520) than with oral tocolysis ($1,390). Charges were lower, however, in the subcutaneous terbutaline group for nursery services ($7,143 vs. $15,050 per patient) and for antepartum hospital charges ($3,986 vs. $5,495, respectively, per patient).

Mean maternal and infant charges totaled $16,649 per patient in the subcutaneous terbutaline group and $21,935 per patient in the oral tocolytics group.

Collectively, $4.6 million was spent on the subcutaneous terbutaline group for antepartum hospitalization, outpatient services, and nursery care for women and their infants, compared with $6.1 million spent for the same services in the oral tocolytics group--a $1.5 million savings, the investigators estimated.

Although the study matched patients for gestational age at preterm labor recurrence, patients in the oral tocolysis group were more than twice as likely to be smokers (10% vs. 4% in the subcutaneous terbutaline group) and were more likely to have had a previous preterm birth (39% vs. 29%, respectively). The subcutaneous terbutaline group contained more married women (84% vs. 69% of patients receiving oral tocolytics).

Women with hypertension, diabetes, or fetal conditions were excluded from the study.

Investigators estimated daily costs of antepartum hospitalization as $1,000, regular nursery days as $500, and NICU stays as $2,000.

Daily outpatient services were estimated to cost $70 for oral tocolytics and $200 for continuous subcutaneous terbutaline.

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