A study of efficacy of intramuscular injection tramadol as labour analgesic and labour accelerator in 400 primigravida patients in latent phase of first stage of labour

Background: Labour pain is among the most severe pain experienced by women. Most women like to experience labour birth with active involvement and as naturally as possible. Hence, the need for analgesia to overcome labour pains is highly requested by women today. In developing nations where availability of facilities is the main limiting factor, intra muscular opioids can be used. The aim was to know the effect of Tramadol in labour analgesia and reduction in the duration of labour and to know the maternal and neonatal outcome after administration of TramadolMethods: This study was conducted in tertiary teaching care hospital in 400 low risk primigravidae who fulfilled selection criteria with full-term pregnancy with vertex presentation in late latent phase of labour were selected and given 100 mg tramadol hydrochloride intramuscularly.Results: The degree of pain relief in 1 st and 2 nd stage of labour, duration of labour, Apgar score of neonates and side effect of drugs were studied. In this study 23.5% of patients had grade II pain, 38.5% of patients had grade III pain and 38% of patients had no pain relief after Tramadol administration. Before drug, the mean pain score is 3.86 in stage I. After drug administration the mean pain score is 3.14 in stage I and 3.81 in stage II. The duration of first and second stage of labour also shortened.Conclusions: In low risk Primigravidae, IM Tramadol hydrochloride appears to be effective without side effects. Hence, in developing nations, where availability of facilities is the main limiting factor, IM opioids can be considered as suitable alternatives.

Effect of epidural labor analgesia in latent phase on the puerperae and their newborns G / 新乡医学院学报

Objective To investigate the effects of epidural labor analgesia in latent phase on the puerperae and their newborns. Methods A total of 240 spontaneous parturient primiparae who received labor analgesia were selected from Decem-ber 2015 to January 2017 in Kaifeng Obstetrics and Gynecology Hospital. The primiparae were divided into observation group and control group,with 120 cases in each group. The puerperae in the observation group were performed with patient-controlled epidural analgesia(PCEA)in the latent phase,and the puerperae in the control group were performed with PCEA in the active phase. The puerperae received PCEA with 10 - 15 mL mixed liquor of ropivacaine mesylate and sufentanil citrate by self-con-trolled analgesia pump after epidural puncture. The time of the first stage of labor(T 1 ),the time of the second stage of labor (T2),visual analogue scale(VAS)score,uterine-incision delivery and the satisfaction degree of analgesia were observed. The blood pressure and heart rate of puerperae during the period of analgesia,and the neonatal Apgar score,the incidence of neo-natal asphyxia were compared between the two groups. Results The T1 and T2 of parturient in the observation group were sig-nificantly shorter than those in the control group (P < 0. 05),and the VAS score was significantly lower than that in the control group (P < 0. 05). There was no significant difference in blood pressure and heart rate between the two groups during the anal-gesia period (P > 0. 05). In the control group,the rate of cesarean section and the satisfaction of analgesia were 10. 83％ and 70. 83％ respectively;the rate of cesarean section and the satisfaction of analgesia were 3. 33％ and 95. 83％ respectively in the observation group. The rate of cesarean section in the observation group was significantly lower than that in the control group (χ2 = 5. 128,P < 0. 05),and the satisfactory rate of analgesia was significantly higher than that in the control group (χ2 = 27. 000,P < 0. 05). There was no significant difference in Apgar score of neonate between the two groups (P > 0. 05). Neonatal asphyxia rates in control group and observation group was 3. 0％ and 2. 5％ respectively;there was no significant difference in asphyxia rate between the two groups (χ2 = 0. 147,P > 0. 05). Conclusion The effect of epidural labor analgesia in latent phase is satisfactory. It can shorten the birth process and reduce the rate of cesarean section,and the maternal and in-fant risk is not increased.

Does Admission in Labour Room During Latent Phase of Labour Versus Active Phase Really Matters in Low Risk Women Presenting at Term? A Cross-Sectional Observational Study.

Background: The management of labour and its complication is an issue of great importance worldwide. Still it is unclear from available information that when to admit a Women in labour in order to achieve maximum maternal and fetal benefit. The present study was an attempt to assess how the outcome of woman changed with timing of admission either in active or latent phase of spontaneous labour in a tertiary care hospital. Aim: 1) To determine and compare the rate of intervention among low risk women admitted in latent and active phase of labour. 2) To determine and compare the rate of complications among them. 3) To determine and compare the foetal APGAR Scores and admission to NICU. Methods: It’s a cross-sectional observational study, conducted at NIMS Hospital, Jaipur from a period between October 2015 to July 2016 with Sample Size of 180 low risk term women presenting during latent or active phase of labour. Result: Out of 180 patients, 96 patients (53.3%)were admitted during latent phase (group I) and 84 patients (46.7%) during active phase of labour (group II). Duration of labour was significantly greater in-group I compared to group II (mean± SD 17.0 ± 2.1 vs 12.7 ± 3.2). Caesarean was more in group I compared to group II (62.5% vs 28.5%) which was significant. Most common indication of caesarean was dystocia followed by fetal distress. Augmentation with oxytocin was required in 66 cases (68.75%) in group I and 42 cases (50.0%) in group II and the difference was not significant. Although PPH, cervical and perineal tear,fetal distress was more in group I but the difference was insignificant.

Tratamiento activo con oxitocina y rotura artificial tardía de membranas en la distocia de fase latente del trabajo de parto / Active treatment with oxytocin and late artificial rupture of membranes in the dystocia of the latent phase of labor

Se realizó un estudio prospectivo, longitudinal y de intervención, de las 90 gestantes con fase latente prolongada del trabajo de parto, a partir de ocho horas, atendidas en el Servicio de Perinatología del Hospital "Mariana Grajales Coello" y "Juan Bruno Zayas Alfonso" de Santiago de Cuba, en el período 2011-2013, con el objetivo de demostrar la utilidad del tratamiento activo con rotura artificial de membrana tardía, empleado en la fase latente prolongada del trabajo de parto. Se obtuvo que el tiempo promedio para alcanzar la fase activa después de iniciada la conducción fue de 5,08 horas y 80,3 % de las mujeres tuvieron respuesta rápida; mientras que la duración de la fase activa fue de 4,05 horas como promedio. Se demostró la utilidad del nuevo protocolo terapéutico para la distocia de fase latente.

A prospective, longitudinal intervention study, of the 90 pregnant women with prolonged latent phase of labor, from eight hours on, assisted in the Perinatology Service of "Mariana Grajales Coello" and "Juan Bruno Zayas Alfonso" Hospitals in Santiago de Cuba was carried out in the period 2011-2013, with the objective of demonstrating the usefulness of the active treatment with late artificial rupture of membrane, used in the prolonged latent phase of labor. It was obtained that the average time to reach the active phase after initiating the induction was of 5,08 hours and 80,3% of the women had a fast response; while the duration of the active phase was of 4,05 hours as average. The usefulness of the new therapeutic protocol for the dystocia of latent phase was demonstrated.

Modalidades terapéuticas en la fase latente prolongada del trabajo de parto / Therapeutic modalities in the prolonged latent phase of labor

En el trabajo de parto, la distocia de fase latente constituye una entidad clínica relacionada con el aumento de la morbilidad y mortalidad materna y perinatal. En este artículo se exponen las modalidades de tratamiento para el trastorno de esta fase del trabajo de parto, a fin de que los obstetras posean alternativas terapéuticas que posibiliten una mayor preparación en la toma de decisiones. Asimismo, se describen tanto las formas de terapia conservadora (reposo terapéutico), como las de la activa. Se concluye que el tratamiento activo no invasivo de base etiológica con misoprostol y la terapia activa con oxitocina y rotura artificial de membranas tardía, son modalidades empleadas en obstetricia con resultados satisfactorios.

Dystocia of latent phase constitutes a clinical entity related to the increase of maternal and perinatal morbidity and mortality during labor. The treatment modalities for the disorder of this phase of labor are exposed in this work, so that the obstetricians have therapeutic alternatives which facilitate a greater preparation in the decision-making process. The ways for conservative therapy (therapeutic rest) and active therapy are also described. It is concluded that the non-invasive active treatment of etiological basis with misoprostol and the active therapy with oxytocin and late artificial rupture of membranes are the modalities used in obstetrics with satisfactory results.