The Effect of Hyoscine Butylbromide on Shortening of First and Second Stages of Labor
Status:
Completed
Trial end date:
2016-06-01
Target enrollment:
Participant gender:
Summary
The management of normal labor is both an art and a science. For decades, health providers
have worked to manage labor actively and safely, with the goal of shortening the duration of
painful labor. Reduction of Cesarean sections and other fetal and maternal complications is
also an important aspect of labor management.
The safety of active management of labor has been demonstrated by several prospective
randomized clinical trials. A shorter duration of labor from admission to delivery has also
been consistently reported in numerous studies of women treated with the active management
protocol.Hyoscine butylbromide belongs to the parasympatholytic group of drugs and is a
semisynthetic derivative of scopolamine. It is an effective antispasmodic drug without the
untoward side effects of atropine. Hyoscine butylbromide is a quaternary ammonium compound
and has peripheral anticholinergic action, but no central action as it does not cross the
blood-brain barrier. Hyoscine butylbromide acts primarily by blocking the transmission of
neural impulses in the intraneural parasympathetic ganglia of abdominal organs, apparently
inhibiting cholinergic transmission in the synapses of the abdominal and pelvic
parasympathetic ganglia, thus relieving spasms in the smooth muscles of gastrointestinal,
biliary, urinary tract, and female genital organs, especially the cervico-uterine plexus,
thus aiding cervical dilatation.
Spasmolytic drugs are frequently employed in delivery rooms to overcome cervical spasms and
thus reduce the duration of labor.
Hyoscine butyl bromide has been used to shorten the duration of labor in several hospitals in
the world. The mechanism by which it acts in the context of labor has not yet been
elucidated, and evidence of its efficacy has been largely anecdotal.
Major studies have been carried out to evaluate the effects of the injectable or suppository
form of Hyoscine butyl bromide on cervical dilatation; a majority of these studies
demonstrated the efficacy of Hyoscine butyl bromide in augmenting labor. However, a few
studies showed no effect of Hyoscine Butyl bromide on accelerating labor. In addition, some
studies also used oxytocin in active management of labor, which would certainly affect the
duration of labor and increase bias in the results. The specific objectives of this study
will be to assess whether Hyoscine butyl bromide is effective in hastening cervical
effacement and dilatation, thus shortening the duration of the first and second stages of
labor with or without labor augmentation. We also intended to determine whether the use of
Hyoscine butyl bromide in the first and second stages of labor has any associated increases
in complications, such as an increase in blood loss or the rate of cesarean deliveries.