Use of an Antiemetic to Shorten the Length of Labor in Nulliparous Women
Study Details
Study Description
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 child birth experience.
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.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 4 |
Detailed Description
Women who will fulfill the study inclusion and exclusion criteria and agree to be included in the study will be randomized assigned to receive either an intravenous injection of 10mg metoclopramide (Group 1) or the same volume of placebo, i.e. 0.9% sodium chloride (Group2). Randomization will be achieved using computer generated randomization sequences. Allocation will be in 1:1 ratio. Record of group allocation will be maintained by a resident physician whose responsibility is randomization and drawing up the injection, but has no direct involvement in the intrapartum decision making.
After through history and physical examination, each participant will take the selected medication slowly IV over 2 min, the assigned medication will be repeated every two hours for a maximum of three doses.
Monitoring of fetal well-being and labor progress with Partographic representation will be performed.
Management of labor will be according the labor and delivery standard protocol, if labor dilatation will not progress appropriately, i.e. cervical dilatation rate of <1cm/hour, amniotomy will be performed if membranes are intact. Oxytocin augmentation will be considered after rupture of membranes only if the cervix remains unchanged on two consecutive pelvic examination conducted two hours apart. Oxytocin infusion will start with 5mIU/min and increase by 5mIU/min every 15min to achieve seven contractions in 15 min, the maximal rate of oxytocin being 30Miu/min.
The following parameters will be recorded for every patient:
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Timing of metoclopramide or placebo injections
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Timing of full dilatation of cervix
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Duration of first stage of labor
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Duration of second stage of labor
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Duration of third stage of labor
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Mode of delivery
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Injection to delivery interval
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Cervical dilatation rate
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Neonatal condition at birth
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: Metoclopramide Intravenous injection of 10mg metoclopramide |
Drug: Metoclopramide
Intravenous injection of 10mg metoclopramide, at enrollment, then every 2 hours.
Maximum of 3 doses.
Other Names:
|
| Placebo Comparator: Placebo Intravenous injection of 0.9% sodium chloride |
Drug: Placebo
Intravenous injection of 0.9% sodium chloride, at enrollment, then every 2 hours.
Maximum of 3 doses.
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Cervical dilatation rate [6 hours]
Secondary Outcome Measures
- Duration of the first stage of labor [6 hours]
Other Outcome Measures
- Duration of the second stage of labor [2 hours]
- Duration of the third stage of labor [1 hour]
- Number of Participants with Adverse Events [24 hours]
Adverse effects of metoclopramide: Cardiovascular: heart block, bradycardia, heart failure, flushing, hyper or hypotension, supraventricular tachycardia. Central nervous system: Drowsiness, acute dystonic reactions, headache, dizziness, akathisia, confusion, depression, hallucinations, Parkinsonian-like symptoms, suicidal ideation, seizure, tardive dyskinesia Dermatologic: Angioneurotic edema, rash, urticaria Gastrointestinal: Nausea, vomiting, diarrhea Respiratory: Bronchospasm, laryngeal edema (rare), laryngospasm (rare)
- Apgar score [10 minutes]
- Meconium stained liquor [6 hours]
- Neonatal intensive care unit admission rate [24 hours]
- Rate of vaginal delivery [12 hours]
- Number of participants with genital tract injuries [2 hours]
genital tract injuries: Perineal tears Vaginal tears Cervical tears Perineal hematomas Vaginal hematomas Uterine rupture
Eligibility Criteria
Criteria
Inclusion Criteria:
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Primigravida
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Singleton pregnancy
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Term gestation i.e. 37- 42 weeks
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Sure reliable dates
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Vertex presentation, occipitoanterior position
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Spontaneous onset of labor
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Regular uterine contractions at every 5 min ,each lasting for 20 sec
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Cervical dilatation of 3-5cm
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With or without rupture of membranes
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No evidence of maternal or fetal distress
Exclusion Criteria:
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Mal-presentations
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Mal-positions
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Multifetal pregnancy
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Cephalopelvic disproportion
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history of cervical surgery or injury
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Hypersensitivity to metoclopramide
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Labor and delivery ward of Armed Forces Hospital, Southern Region. | Khamis Mushait | Saudi Arabia | 101 |
Sponsors and Collaborators
- Ain Shams University
- Armed Forces Hospitals, Southern Region, Saudi Arabia
Investigators
- Study Director: Mohamed I Ellaithy, MD, Ain Shams University
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- AFHSR-13-7-2013