We read with interest the study by Guinn et
al (Guinn DA, Goepfert AP, Owen], Wenstrom KD,
Hauth ]C. Terbutaline pump maintenance therapy for
prevention of pre term delivery: a double-blind trial. Am]
Obstet GynecoI1998;179:874-8) regarding subcutaneous
terbutaline for prevention of preterm delivery. This study
unfortunately tells us nothing about the efficacy of this
therapy as it is commonly prescribed by obstetricians.
During the study period (November 1994-April 1997)
Guinn et al discharged their patients home without daily
nursing contact or home uterine contraction monitoring,
both of which are the standard of care and are necessary
for the use of subcutaneous terbutaline therapy
outside the hospital setting. Objective data are essential
for individual dosage changes (increased drug delivery
during times of documented increased uterine activity),
as one would do in the hospital. When daily monitoring
and nursing contact have been included, positive efficacy
and safety results have been confirmed. I , 2 Terbutaline
dosage in the study of Guinn et al was determined without
appropriate consideration of individual body mass
index, contraction activity, or cervical status, as is the
standard practice. In light of the 3- to 4-hour half-life of
terbutaline during pregnancy and the fact that no patients
received scheduled drug boluses between 11 PM
and 7 AM (usual periods of peak contraction activity), patients
were likely to have subtherapeutic drug levels by
morning.