Single injection of terbutaline in term labor. I. Effect on fetal pH in cases with prolonged bradycardia

I. Ingemarsson, S. Arulkumaran, S. S. Ratnam

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29 Citations (Scopus)

Abstract

Thirty-three patients with prolonged fetal bradycardia (fetal heart rate baseline <100 bpm for a minimum of 3 minutes of <80 bpm for at least 2 minutes) in labor were studied. They were treated with a bolus injection of terbutaline if the bradycardia persisted at <80 bpm for 2 minutes and other efforts to improve the fetal heart rate (oxygen, positional changes) had failed. After the bolus injection a scalp blood pH (or a cord arterial pH in abdominal deliveries) was obtained within 30 minutes. Fetal acidosis was common if the bradycardia lasted 10 minutes or more, particularly if the rate was <80 bpm with a flat baseline for 4 minutes or more. The fetal heart rate improved after injection in 30 cases; 23 patients had vaginal delivery of infants in good condition. Ten underwent cesarean section: three for no improvement in fetal heart rate, two for cord prolapse, four for later ominous fetal heart rate, and one for failure to progress. These results suggest that tocolysis in selected cases can be of benefit for the fetus with prolonged bradycardia. In cases with an ominous fetal heart rate pattern preceding the bradycardia and in abruptio placentae immediate operative intervention without delay is probably better. Administration of terbutaline should be regarded as a temporary measure until it is apparent that the fetal heart rate has recovered. Preparation for emergency delivery should be made while a recovery is awaited.

Original languageEnglish
Pages (from-to)859-865
Number of pages7
JournalAmerican Journal of Obstetrics and Gynecology
Volume153
Issue number8
DOIs
Publication statusPublished - 15 Dec 1985

Keywords

  • fetal pH
  • prolonged fetal bradycardia
  • Terbutaline

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