Candidates for tocolysis are women in preterm labor between 24 and 34 to 36 weeks of gestation. Prior to 23 weeks, chances of survival of the fetus are remote and the probability of permanent disability high. At about 25 weeks, even a 2-day increase in length of gestation can add 10 percent to the likelihood of neonatal survival. Beyond 34 to 36 weeks, the infant should be mature enough to do well without specific treatment, and the possible side effects of tocolysis are to be avoided.
The decision to institute tocolysis should be made only after consultation with the obstetrician who will be caring for the patient and who can explain the risks and benefits (see T.a.ble..,101..:6). Tocolytics should not be given if abruption is suspected.
Protocols for tocolysis are shown in Table 1.01:7.. b-adrenergic agents have been shown to have serious side effects. However, terbutaline (Brethine), 0.25 mg given subcutaneously and repeated hourly as needed until contractions stop, is commonly used. Common side effects include tachycardia, hypotension, palpitations, headaches, and tremor. Terbutaline should be withheld if the maternal pulse exceeds 140 beats per minute. The combination of magnesium sulfate and nifedipine is potentially dangerous, since nifedipine can enhance the toxicity of magnesium and result in neuromuscular blockade, interfering with both pulmonary and cardiac function. Careful monitoring of the mother and fetus with use of any of these agents, alone or in combination, is mandatory.
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