Drotaverine to improve progression of labour among parturient women- a case control study
Keywords:Cervical dilation, Drotaverine hydrochloride, Labour augmentation
Background: Prolonged labour contributes to increased perinatal and maternal morbidity. Pharmacological interventions can hasten cervical dilation and help obstetrician to accomplish the delivery in the shortest possible time without compromising maternal and fetal safety. Aims and objectives were to evaluate the acceleration effect of drotaverine on the dilatation of the cervix in both primigravidae and multigravida and compare it with control group.
Methods: A total of 70 patients were studied (35 in drotaverine group and 35 in control group). The inclusion criteria were pregnancy with at least 37 weeks completed, cervical dilatation 3-4 cm, regular uterine contractions and cephalic presentation. The study group received 40 mg drotaverine hydrochloride i.m. in active phase of labour, control group received standard delivery care. Parameters such as duration of first and second stage of labour, mode of delivery, neonatal outcome and side effects to drug was recorded.
Results: 6 subjects from the study group and 4 from the control group developed complications in first stage of labour and were taken up for operative delivery and hence they were excluded from calculation of various labour parameters. The mean rate of cervical dilatation with drotaverine was 2.26 cm/hour, while it was 1.67 cm/hour without any intervention (p value <0.05). Mean duration of active phase of first stage of labor was 3.09 hours in drotaverine group against 4.98 hours in study group (p value <0.05). There were no significant untoward effects noted in either of the groups.
Conclusions: Drotaverine was found to be an effective and safe drug in shortening the duration of the first stage of labor without any significant detrimental effects on the mother and newborn. Drotaverine did not interfere with uterine contractility and there was no increased incidence of operative deliveries.
Sir Sabaratnam Arulkumaran, Gita Arjun, Leonie Penna. Psychopharmacology of labour, The Management of Labour. 3rd ed. 2012;1:1.
Madhu C, Mahavarkar S, Bhave S. A randomized Controlled study comparing drotaverine hydrochloride and valethamate bromide in the augmentation of Labour. Arch Gynecol Obstet. 2010;282:11-15.
Leppert PC. Anatomy and physiology of cervical ripening. Clin Obstet Gynaecol. 1995;38(2):267-78.
Gupta K. Emerging role of drotaverine in emergency medicine: A review. J Am Med Assoc Ind Phys Update. 1999;2:57-64.
Granstrom L, Ekman G, Malmstrom A. Insufficient remodelling of the uterine connective tissue in women with protracted labour. Br J Obstet Gynaecol. 1991;98(12):1212-6.
Mishra SL, Toshniwal A, Banerjee R. Effect of drotaverine on cervical dilatation: a comparative Study with epidosin (valethamate bromide). J Obstet Gynaecol India. 2002;52(3):76-9.
Singh KC, Jain P, Goel N, Saxena A. Drotaverine hydrochloride for augmentation of labour. Int J Gynecol Obstet. 2004;84(1):17-22.
Roy A, Patra KK, Mukhopadhyay S, Guha S. Study of drotaverine on first stage of labour and pregnancy outcome. J Indian Med Assoc. 2007;105(8):450-2.
Sharma JB, Pundir P, Kumar A, Murthy NS. Drotaverine hydrochloride versus valathamate bromide in acceleration of labour. Int J Gynaecol Obstet. 2001;74(3):255-60.
Sinhasane H, Nishty GM. A comparative study on the efficacy of drotaverine and valethamate on cervical dilatation during labour. Int J Reprod Contracept Obstet Gynecol. 2017;6(2).
Gupta K, Mukharjee K, Chowdhary B. Effect of drotaverine on the first stage of labour. Obstet Gynaecol Today. 2003;8(3).
Pai MV, Sreekumar S, Gupta K, Chatterjee N. Effect of drotaverine on active phase of labour. Obs Gynae Today. 2003;VIIII(3).
Ibrahim MI, Alzeeniny HA, Ellaithy MI, Salama AH, Abdellatif MA. Drotaverine to improve progression of labor among nulliparous women. Int J Gynaecol Obstet. 2014;124(2):112-7.