Drotaverine to Shorten the Length of Labor
Reducing the length of labor is a highly desirable goal of intrapartum care, both from a perspective of maternal and fetal well-being, and for the providers of the birth services. Avoiding along, protracted labor entails shorter exposure to pain, anxiety and stress and would thus translate into a major improvement in maternal satisfaction with the childbirth experience.
Based on the premise that shortening the length of labor is beneficial, interventions aimed at accelerating the progression of labor have been introduced routinely as part of standard labor management and care throughout the 20th century. Certain labor accelerative procedures, such as amniotomy, became common practice and have been put to the acid test of randomized control trials to evaluate their efficacy. Use of anticholinergics/antispasmodics as a method of augmenting labor was ﬁrst described in 1937 by Hirsch, who reported a decrease in labor length by two to four hours following Intrapartum administration of an atropine-like drug (Syntropan®)mainly among older nulliparas.
Drotaverine, an isoquinolone derivative is a superior smooth muscle relaxant which acts specifically on spastic sites and corrects the cAMP and calcium balance relieving smooth muscle spasm.
This inhibitory action is detected only in lower uterine segment during labor since muscle fibers in upper uterine segment are strongly affected by contractile effect of oxytocin. Use of drotaverine during pregnancy is free of any teratogenic and embryotoxic effects.
The Research question is: Does the use of antispasmodic Drotaverine shorten the duration of active first stage of labor in nulliparous women as compared to placebo?
Prolonged First Stage of Labor
Failure of Cervical Dilation as Antepartum Condition
Mild Birth Asphyxia, APGAR 4-7
|Study Design:||Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator)
Primary Purpose: Treatment
|Official Title:||Use of Antispasmodic Drotaverine to Shorten the Length of Labor in Nulliparous Women|
- Duration of the active first stage of labor [ Time Frame: 12 hours ] [ Designated as safety issue: No ]
- Rate of cervical dilation (cm/h) [ Time Frame: 12 hours ] [ Designated as safety issue: No ]
- Effect on pain by using visual analogue scale [ Time Frame: 12 hours ] [ Designated as safety issue: No ]
- Mode of delivery [ Time Frame: 12 hours ] [ Designated as safety issue: No ]
- APGAR score less than 7 at 1 and 5 minutes [ Time Frame: 12 hours ] [ Designated as safety issue: Yes ]
|Study Start Date:||May 2012|
|Study Completion Date:||January 2013|
|Primary Completion Date:||December 2012 (Final data collection date for primary outcome measure)|
Active Comparator: Drotaverine
Women who will receive 40 mg Drotaverine hydrochloride (Do-Spa) IV injection.
40 mg Drotaverine hydrochloride (Do-Spa) IV injection at the start of the study and repeated every 2 hours up to a maximum 3 injections.
Other Name: Do Spa
Placebo Comparator: Placebo
Women who will receive 2ml of normal physiological saline (0.9% sodium chloride) I.V.
Women who will receive 2ml of normal physiological saline (0.9% sodium chloride) I.V at the start of the active phase of labor.
Other Name: Normal physiological saline (0.9% sodium chloride)
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|Labor at the delivery unit of Ain Shams Maternity Hospital|
|Abbasiya, Cairo, Egypt, 11566|
|Study Director:||Mostafa Ibrahem, MD||Ain Shams University|
|Study Chair:||Mohamed Ellaithy, MD||Ain Shams University|