Antispasmodics for labour

Abstract

Prolonged labour can lead to increased maternal and neonatal mortality and morbidity due to increased risks of maternal exhaustion, postpartum haemorrhage and sepsis, fetal distress and asphyxia and requires early detection and appropriate clinical response. The risks for complications of prolonged labour are much greater in poor resource settings. Active management of labour versus physiological, expectant management, has shown to decrease the occurrence of prolonged labour. Administering antispasmodics during labour could also lead to faster and more effective dilatation of the cervix. Interventions to shorten labour, such as antispasmodics, can be used as a preventative or a treatment strategy in order to decrease the incidence of prolonged labour. As the evidence to support this is still largely anecdotal around the world, there is a need to systematically review the available evidence to obtain a valid answer. Objectives To assess the effects of antispasmodics on labour in term pregnancies. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (2 September 2011), the ProQuest dissertation and thesis database, the dissertation database of the University of Stellenbosch (2 September 2011), Google Scholar (2 September 2011) and reference lists of articles.We also contacted pharmaceutical companies and experts in the field.We did not apply language restrictions. Selection criteria Randomised controlled trials comparing antispasmodics with placebo or no medication in women with term pregnancies. Data collection and analysis Two review authors independently screened abstracts and selected studies for inclusion, assessed risk of bias and extracted data. Data were checked for accuracy. We contacted trial authors when data were missing. Main results Nineteen trials (n = 2798) were included in the review. Fifteen trials (n = 2129) were included in the meta-analysis. Antispasmodics used included valethamate bromide, hyoscine butyl-bromide, drotaverine hydrochloride, rociverine and camylofin dihydrochloride. Most studies included antispasmodics as part of their package of active management of labour. Overall, the quality of studies was poor, as only four trials were assessed as low risk of bias. Eleven trials (n = 1507) reported on the duration of first stage of labour,