Journal of Rawalpindi Medical College (JRMC); 2013;17(2):238-239

Original Article Efficacy of Phloroglucinol Versus Placebo on the Duration of Labour in Term Pregnancies

Noreen Anjum, Farah Rehana, Farzana Qazmi Department of Obstetrics and Gynaecology, District Headquarters Hospital, Rawalpindi

Abstract first stage of labour was shortened by almost two hours in patients who received phloroglucinol.3 Background: To determine the efficacy of phloroglucinol in terms of duration of first stage of Patients and Methods labour This randomized controlled trial was conducted at Methods: In this randomized, controlled trial Department of Obstetric and Gynaecology DHQ patients were divided into two groups as group A teaching hospital,from February 2009 to July 2009. All (phloroglucinol drug) and group B ( placebo). Sixty term primigravidae 18 yrs or older, having singleton one patients in the drug group received fetus with cephalic presentation, in active phase of phloroglucinol 40mg (4ml) I/V at >3cm dilatation uncomplicated labour were included. Any Sixty one in the placebo group recieved distilled contraindication to vaginal delivery e.g. CPD, placenta water 4ml I/V at >3cm dilatation. Dose was repeated previa, Multigravida, Multiple gestation, pre-term, after 60 min. Maximum 3 doses were given. Half meconium stained liquor, CTG abnormalities and any hourly monitoring of vital signs, uterine contractions obstetrical, surgical or severe medical complications and fetal heart rate was done. Labour progress was such as heart disease or eclampsia were excluded. plotted on partograph. Patients in the drug group (A) (n=61) received Result:Mean gestational age in both groups was phloroglucinol 40mg (4ml) I/V at >3cm dilatation. 38.8 weeks.The mean duration of the observed active Patients in placebo group (B)(n=61) received distilled phase of 1st stage of labour in drug group was 183 water 4ml I/V at >3cm dilatation. Dose was repeated mins and 316 mins in placebo group. The mean after 60 mins. Maximum 3 doses were given. Half duration of 2nd stage of labour in drug group was hourly monitoring of vital signs, uterine contractions 25.16 mins and 34.52 mins in placebo group.The and fetal heart rate was done. Labour progress was mean duration of 3rd stage of labour in drug group plotted on partograph. was 8.72 mins and 11.1 mins in placebo group.The Result mean total duration of labour in drug group was Majority were in age group 22-25 years (Table 1). 216.88 mins and 358.52 mins in placebo group. Mean gestational age in both groups was 38.8 weeks. Conclusion: Phloroglucinol is effective in There were three groups of patients according to the reducing duration of first stage of labour number of doses of drug or placebo used during 1st Key Words: Phloroglucinol, first stage of labour. stage of labour. Thirty seven cases (60.7%) received 1 injection, whereas 17 cases (27.8%) were given 2 Introduction injections and 7 cases (11.5%) received 3 injections during the 1st stage of labour The problems and hazards of prolonged labour, for Table 1: Age distribution ( n= 122) mother and fetus have been recognized. The mother is Age ( years) Case Control Total exposed to high risk of infection, ketosis and obstructed labour, while the fetus faces the danger of 18- 21 15 (24.5%) 18(29.5%) 33 (27%) infection, asphyxia and excessive cranial moulding. 22-25 25 (40.9%) 32 (52.4%) 57 (46.7%) Labour lasting more than 12 hours in nulliparous 26-29 13 (21.3%) 05 (8.1%) 18 (14.7%) women and 8 hours in multiparous women should be > 29 08 (13.1%) 04 (6.5%) 12 (9.8%) regarded as prolonged labour.1 Table 2: Groups of patients according to the Phloroglucinol, an antispastic drug, can relieve the number of doses spasm and edema of cervix and can lower the tension Number of doses used No (%) of cervix muscles. It can be used to improve dilatation 1 37(60.7) of cervix and promote the progression of 2 17(27.8) labour2.Average duration of observed active phase of 3 7(11.5)

238 Journal of Rawalpindi Medical College (JRMC); 2013;17(2):238-239

Table 3: Comparison of duration of labour studied the use of drotavarine for acceleration of between groups labour. In drotavarine group there was a mean 28% Stage of Study Control p- reduction in the duration of 1st stage of labour (p= labour group(min) Group(min) value 0.04).9 Hemangi S et al evaluated camylofin Mean (S.D) Mean (S.D) dihydrochloride in active phase of labour. Mean Active 1st 183.04(35.64) 316.09(52.29) 0.001 duration of 1st stage in study group was 215 mins as Stage compared to 334 mins in control group ( p< 0.001).10 2nd Stage 25.16(6.21) 34.52(5.57) 0.001 Yilmaz B et al found that the mean duration of active 3rd Stage 8.72(3.47) 11.18(2.02) 0.191 1st stage in mepridine group was 103 +/- 64.5 mins in Duration of 216.88(38.94) 358.52(65.88) 0.000 contrast to placebo was 173.9 +/- 74.8 mins (p < labour 0.001).11 Results of different studies reveal potential (Table 2). Duration of active 1st stage of labour was benefits of a reduced 1st stage time include a reduced 183.04+/- (35.64) mins in the drug group and 316.09 incidence of chorioamnionitis, neonatal sepsis and +/- (52.29) mins in the placebo group. There was a puerperal sepsis, all of which are increased in women difference of almost 2 hours in the study and control with prolonged labour. 12,13 group which was statistically significant. (p= 0.001) Conclusion nd The mean duration of 2 stage of labour in drug In the presence of good and regular uterine group was 25.16 mins (6.21) and 34.52 mins (5.57) in contractions phloroglucinol can be used for rd placebo group. (p = 0.001) The mean duration of 3 augmentation of labour, helping the delivery to be stage of labour in drug group was 8.72 mins (3.47) and easy and safe. 11.1 mins (2.02) in placebo group. (p = 0.191).The mean total duration of labour in drug group was References 1. Baker PN, Obstetrics by 10 teachers. 18th ed.London: Arnold; 216.88 mins and 358.52 mins in placebo group. (p = 2006:220. 0.000) The mode of delivery was not altered in 2 2. Hao Y, Zhai GR, Duan AH. Effects of spasfon on course of groups (Table 3). labour. Zhonghua Fu Chan ke Za Zhi 2004;39:606-08. 3. Tabassum S, Afridi B, Aman Z. Phloroglucinol for Discussion acceleration of labour. J Pak Med Assoc 2005;55:270-73. 4. Shields SG, Ratcliffe SD, Fontaine P. Dystocia in nulliparous Dystocia is common in nulliparous women and is women. Am Fam Physician 2007;75:1671-78. responsible for more than 50 % of primary cesarean 5. Tehalia MK, Sajjan GR, Korbu J. Comparitive study of deliveries. If labor is not progressing, inadequate Hyoscine butylbromide versus Drotavaerine hydrochloride uterine contractions, fetal malposition, or CPD may be in first stage of labour. J Obstet Gynecol India 2008;58:3-6. 6. Madhu C, Mahavarkar S, Bhave S. Randomised controlled the cause. Before resorting to operative delivery for study comparing Drotaverine hydrochloride and arrested labor, physicians should ensure that the Valethamate bromide in the augmentation of labour. Arch patient has had adequate uterine contractions for four Gynecol Obstet 2010;282(1):11-15 7. Sharma JB, Pundir P, Kumar A. Drotavarine hydrochloride hours, using oxytocin infusion for augmentation as vs. valethamate bromide in acceleration of labour. Int J needed.4 Gynaecol Obstet 2001;74:255-60. Phloroglucinol accelerates the labour by relieving 8. Roy A, Patra KK, Mukhopadhay S, Guha S. Study of the spasm and edema of cervix and facilitates drotavarine on first stage of labour and pregnancy outcome. 3 J Indian Med Assoc 2007;105:450-52. dilatation. Use of antispasmodic agents like hyosine 9. Singh KC, Jain P, Goel N, Saxena A. Drotaverine butylbromide, dicyclomine valethamate, camylofine hydrochloride for augmentation of labour. Int J Gynaecol dihydrochloride, phloroglucinol trimethylether etc is Obstet 2004;84:17 – 22. advised to hasten the 1st stage of labour.5,6 Many local 10. Himangi S, Anahita R, Vanita S. Efficacy of Camylofin dihydrochloride in acceleration of labour. A randomised and regional studies have been done to study the double blind trial. J Bombey Hosp 2003;4:119-22 effects of phloroglucinol on duration of labour. 6,7 11. Yilmaz Pl. Meperidine versus valethamate bromide in Tehalia MK and Sajjan GR compared the effects of shortening the duration of active labour. Int J Gynaecol hyoscine and Drotavarine in 1st stage of labour. Mean Obstet 2009;107:126-29. 12. Samuels L, Christie L, Roberts – Gittens B. The effect of time to full cervical dilatation was significantly less in hysocine butylbromide o the first stage of labour in term hyoscine group in nulliparas (p< 0.01).5 Roy A and pregnancies. BJOG 2007;114:1542–46. Patra K, studied the effect of drotavarine on 1st stage of 13. Sirohiwal D, Dahiya K, De N. Eficacy of hyoscine-N- st butylbromide Suppositries as a cervical spasmolytic agent in labour, the mean duration of 1 stage of labour in labour. Aust N Z J Obstet Gynaecol 2005;45:128-31. primigravidas was 148.9 mins in drotavarine group and 331.6 mins in control group.8 Singh KC et al

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