Labour Duration and Metoclopramide
Conditions
Keywords
Metoclopramide - labor duration-labor pain
Brief summary
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 a long, protracted labor entails shorter exposure to pain anxiety and stress and would translate into a major improvement in maternal satisfaction with the childbirth experience. Prolonged labor can lead to increased maternal and neonatal morbidity and mortality such as rupture of the uterus, postpartum hemorrhage, puerperal sepsis, and maternal death. Prolonged labor may be due to maternal age, premature rupture of membrane, epidural analgesia and the secretion of high levels of maternal stress hormones.
Detailed description
Several studies showed that active management of labor could shorten the duration of labor, and the safety of this method has been demonstrated. Metoclopramide binds to dopamine receptors acting as a receptor antagonist, and it is also a mixed serotonin receptor agonist and antagonist. Metoclopramide could potentially reduce spasms of the smooth muscle of the cervix that remains richly innervated at birth and thus have a regulatory effect on cervical contractility, an interaction that might be important in aiding maximal tissue compliance, promoting cervical dilatation during labor, and helping to reduce dystocia. Dopamine and other catecholamines have been identified in rabbit, rat, guinea-pig, sheep, and human uteri. The purpose of this study is to determine the effectiveness of metoclopramide for reducing the duration of spontaneous labor among nulliparous women managed according to a standard intrapartum protocol.
Interventions
this group receive 10mg intravenous metoclopramide slowly over 2 minutes the medication will be repeated every 2 hours for a maximum three doses
DRUGPlacebo (0.9 sodium chloride)
this group receive 10mg intravenous placebo(0.9 sodium chloride) slowly over 2 minutes the medication will be repeated every 2 hours for a maximum three doses
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
FEMALE
Healthy volunteers
Yes
Inclusion criteria
* primigravida * singleton pregnancy * termgestation (37-42 weeks) * sure reliable dated * vertex presentation , occipito-anterior position * regular uterine contractions at every 5 minutes,each lasting for 20 seconds * cervical dilatation of 5 cm * with or without rupture of membrane * no evidence of maternal or fetal distress
Exclusion criteria
* chorioamnionitis * scarred uterus e.g. myomectomy * cephalopelvic dispropotion * history of cervical surgery or injury * hypersensitivity to metoclopramide
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| duration of labour | 8-12 hours | cervical dilatation rate in first stage of labour |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| labour pain | pain assessment at 30,60,120 minutes following injection of metoclopramide | effect of metoclopramide on labour pain score using visual analogue scale which is a score from 0 to 10 cm The higher the score represents more pain |
Countries
Egypt
Outcome results
None listed