ABSTRACT
Background: In low- and middle-income countries epidural analgesia is generally not available and practically no form of labor analgesia is given to the majority of the parturient. The purpose of study was to evaluate the safety and efficacy of tramadol as a labor analgesic during first stage of labor.Methods: Pregnant women admitted in the labor room satisfying the eligibility criteria were randomized to receive intramuscular injection of either 100 mg tramadol or 2 ml distilled water. Visual analogue score (VAS) was assessed at the beginning and every hour till 4 hours. Pain satisfaction, duration of second stage of labor, fetal heart rate, mode of delivery, and any maternal side effects of the study drug were recorded. Neonatal evaluation using Apgar score at 1 and 5 minutes was done. For statistical analysis Student t-test, Chi Square test and Fisher’s exact test were used.Results: Total of 86 women were included in the study. The VAS scores were significantly lower in the tramadol group at 1, 2 and 3 hours after the administration. Pain relief satisfaction was significantly higher in the tramadol group. Rate of cervical dilatation, duration of the second and the third stage, need for instrumental delivery or lower segment caesarean section, rate of fetal distress and Apgar score at one and five minutes were comparable in both the groups. Nausea was significantly higher in tramadol group.Conclusions: Tramadol is a safe and efficacious drug which is inexpensive, easily available and easy to administer with few minor side effects. It can be used as a labour analgesic as an alternative to epidural analgesia in settings where epidural analgesia is not available. Trial registration: Clinicaltrials.gov PRS registration number: NCT02999594.
ABSTRACT
Aim: To assess the efficacy, safety and acceptability of mifepristone followed by vaginal misoprostol for medical termination of pregnancy (MTP) between 13-20 weeks of gestation. Material and methods: Forty women who fulfilled the criteria of MTP Act of India, were given 200 mg oral mifepristone, followed after 36-48 hours by 800 μg vaginal misoprostol and subsequently 400 μg vaginal misoprostol 3-hourly (maximum 2,400 μg). Success was taken as complete expulsion of fetus and placenta within 15 hours of first dose of misoprostol. Results: Success rate of complete abortion was 92.5%, which increased to 95% at 24 hours and successful expulsion of fetus was seen in 100% cases within 24 hours of first dose of misoprostol. Median induction-abortion interval was 6 hours. There were no major side effects. Nulliparous women took significantly longer time to abortion and required more analgesia than multiparous women. Conclusion: Mifepristone followed by vaginal misoprostol is a safe, effective and acceptable method for second trimester termination of pregnancy.