The Effect of Intramuscular Administration of Atropine and Hyoscine Combination on Labor Progress and Maternal and Neonatal Outcomes in Primigravid Women

Document Type: Original Article

Authors

1 Associated Professor, Department of Obstetrics and Gynecology, Taleghani Hospital, Arak University of Medical Sciences, Arak, Iran

2 Assistant Professor, Gynecologist, Department of Obstetrics and Gynecology, Arak University of Medical Sciences, Arak, Iran

3 Assistant Professor, Department of Social Medicine, Arak University of Medical Sciences, Arak, Iran

Abstract

Background: Previous studies reported that neonatal and maternal complications as well as duration of labor could be diminished through labor management. Therefore, we aimed to evaluate the effect of intramuscular (IM) administration of atropine and hyoscine combination on labor progress and maternal and neonatal outcomes in primigravid women admitted to Taleghani Hospital of Arak, Iran.
Methods: In this double-blind, placebo-controlled clinical trial, 216 primigravid women were randomly allocated to four groups (54 cases in each group) as follows: atropine group received 0.01-0.5 mg (1cc) of IM atropine; hyoscine group received 20 mg of IM hyoscine in a single dose; atropine and hyoscine combination group received 0.01-0.5 mg of atropine and 20 mg of IM hyoscine in a single dose; and control group only received IM injection of 1cc distilled water in a single dose. Thereafter, Bishop score, duration of the active phase and the second stage of labor, type of delivery, and Apgar scores at one and five minutes were recorded. Chi-square/Fisher’s exact tests and One-way ANOVA were run, using SPSS version 20.
Results: The Bishop scores were significantly higher in the atropine and hyoscine groups, compared to the other groups (P<0.05). Duration of the active phase in the atropine and hyoscine combination group was significantly shorter than the other groups (P=0.001). However, there was not a significant difference between the four groups in terms of duration of the second stage and Apgar scores at one and five minutes (P>0.05).

Conclusion: The atropine and hyoscine combination reduced the duration of active phase in the primigravid women without serious maternal or neonatal adverse effects.

Keywords


  1. Cuningham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap LC, Wenstrom KD. Williams Obstetrics. 22nd ed. New York: McGRAW Hill Medical Publishing Division; 2009. P. 153-4, 422-3, 476.
  2. Zargari A. Herbal medicine. 5th ed. Tehran: Tehran University CO; 2001. P. 4.
  3. Hotwani J, Ainapure SS. Hyoscine butylbromide suppositories. Ind Med Gaz. 2000; 1:217–9.
  4. Samuels LA, Christie L, Roberts-Gittens B, Fletcher H, Frederick J. The effect of hyoscine butylbromide on the first stage of labour in term pregnancies. BJOG. 2007; 114(12):1542–6.
  5. Anthony JT, Bertram GK, Susan BM. Pharmacology examination and board review. 8th ed. Singapore: McGraw-Hill Medical; 2007.
  6. Saatsaz S, Haji Ahmadi M, Basirat Z, Nazari R, Beheshti Z. Comparison of atropine drugs-promethazine and pethidine on the active phase of labor. J Babol Univ Med Sci. 2007; 38(3):39-42
  7. Tabarraei Y, Dargahi R, Azari M, Mard A, Rahimi G, Refahi S. The effect of intravenous injection of Atropine with hyoscine on the progress of labor in primiparous women in Alavi hospital, Ardabil, Iran. Life Sci J. 2013; 10(5):649-51.
  8. Sirohiwal D, Dahiya K, De M. Efficacy of hyoscine-N-butylbromide (Buscopan) suppositories as a cervical spasmolytic agent in Labour. Aust N Z J Obstet Gynaecol. 2005; 45(2):128–9.
  9. Tewari K, Jabeen R, Sabzposh MA, Rabbani T. Comparison of hyoscine-butylbromide and valethamate bromide in shortening the duration of labor. Ind Med Gaz. 2003; 137:15–9.
10. Gupta B, Nellore V, Mittal S. Drotaverine hydrochloride versushyoscine-N-butylbromide in augmentation of labor. Int J Gynaecol Obstet. 2008; 100(3):244–7.

11. Aggarwal P, Zutshi V, Batra S. Role of hyoscine N-butyl bromide (HBB, buscopan) as labor analgesic. Ind J Med Sci. 2008; 62(5):179–84.

12. Frigoletto FD Jr, Lieberman E, Lang JM, Cohen A, Barss V, Ringer S, et al. A clinical trial of active management of labour. N Engl J Med. 1995; 333(12):745–50.

13. Sadler LC, Davison T, McCowan LM. A randomised controlled trial and meta-analysis of active management of labour. BJOG. 2000; 107(7):909–15.

14. Mortazavi F, Rakhshani MH. The effect of atropine, hyoscine and promethazine on the duration of labor stages and rate of labor progress in multiparous women. J Gorgan Univ Med Sci. 2005; 6(2):92-6.

15. Qahtani NH, Hajeri FA. The effect of hyoscine butylbromide in shortening the first stage of labor: a double blind, randomized, controlled clinical trial. Ther Clin Risk Manag. 2011; 7:495–500.

16. Shedid AA. Rectal hyoscine-N-butylbromide safely accelerates progress of labor in primipara: a placebo-controlled study. J Am Sci. 2012; 8(8):517-22.

17. Makvandi S, Tadayon M, Abbaspour M. Effect of hyoscine-N-butyl bromide rectal suppository on labor progress in primigravid women: randomized double-blind placebo-controlled clinical trial. Croat Med J. 2011; 52(2):159-63.

18. Gupta B, Nellore V, Mittal S. Drotaverine hydrochloride versus hyoscine-N-butylbromide in augmentation of labor. Int J Gynaecol Obstet. 2008; 100(3):244-7.

Zhang J, Troendle J, Mikolajczyk R, Sundaram R, Beaver J, Fraser W. The natural history of the