Study to determine feto maternal outcomes of programmed labor in a tertiary care hospital of Jharkhand
Keywords:Labor, Analgesia, Pain, Singleton, Satisfaction, Paracetamol
Background: Programmed labor aims to minimize duration and inconvenience of labor both for patient and obstetrician. The present study attempts to provide labor analgesia by using infusion paracetamol in place of conventional ketamine and tramadol.
Methods: This study was conducted in the labor room of department of obstetrics and gynecology, RIMS, Ranchi from March 2019 to February 2020. 50 primigravida and 50 multigravidas were studied, with singleton pregnancy, cephalic presentation presenting with spontaneous onset of labor with Gestational age of 37-41 week.
Results: 30% of patients were greater than 40 weeks gestation.65% of primigravida experienced severe pain, but only 20% of multigravidas had severe pain.60%primigravidas and 60% multigravidas (of 20% who had severe pain) experienced adequate pain relief with labor analgesia. 60 % primigravida presented with <4 cm cervical dilatation, whereas 40% multigravidas had <4 cm dilatation. 60% primigravida had shortened active phase (3.5 hrs), 60% multigravidas (2.5 hrs) which is suggestive of benefit of obstetrical analgesia in programmed labor. 90% patients had third stage labor less than 3 minutes. Only one multigravida landed in postpartum hemorrhage. All neonates had Apgar score greater than 8. There was no perinatal mortality. Only one primigravida landed in caesarean section due to arrest in second stage. 2 multigravidas had instrumental delivery. Maternal side effects like tachycardia, nausea, cervical and vaginal tears were more in primigravida.
Conclusions: Participants with good response to obstetrical analgesia fared better than rest. Response was more satisfactory in primigravida in terms of labor progress.
Daftary SN, Desai SV, Thanawala U, Bhide A, Levi J, Patki A, et al. Programmed labor - indigenous protocol to optimize labor outcome. South Asian Feder Obstet Gynecol. 2009;1:61-4
Spong CY, Cunningham FG, Leveno KJ, Bloom SL, Hauth J, Rouse D. Obstetric analgesia. Williams-Obstetrics. 23rd ed. New York: McGraw-Hill; 2010: 454.
Raffin RB, Friderichs E, Reiman W. Obstetric analgesics and anesthetics. J Pharmacol Experiment Therap. 1992;260:275-85.
Levi J. Obstetric analgesia and anesthesia. USA: ACOG publishers; 2002.
Gupta K, Dubey S, Bhardwaj S, Parmar M. A programmed labor protocol for optimizing labor and delivery. Int J Reprod Contracept Obstet Gynecol. 2015;4:457-60.
Jyoti M, Singhal P, Choudhary D. Programmed labor. J Obstet Gynecol India. 2006;56:53.
Irene V, Kaur V. Programmed labor for optimizing labor & delivery. JK Sci. 2008;10:62-4.
Chauhan R, Gupta AA. A clinical study of programmed labor & its outcome. J Obstet Gynecol Fam Welfare. 2003;5:8-9.
Mishra SL, Toshniwal A. Effect of drotaverine HCL on cervical dilatation in labor, a comparison with valethamate bromide. J Obstet Gynecol India. 2002;52: 76.
Singh KC, Jain P, Goel N. Drotaverine hydrochloride for augmentation of labor. Int J Gynaecol Obstet. 2004; 84:17-22.