The Effect of Metoclopramide on the Length of First Stage of Labor and on Labor Pain in Nulliparous Women, A Randomized Controlled Trial

Abstract

Background: Prolonged labor can lead to increased maternal and neonatal morbidity and mortality. The two main factors that determine duration of labor are cervical dilatation and effacement . Several studies showed that active management of labor could shorten the duration of labor through mechanical, pharmacological and non-pharmacological factors that can increase cervical dilatation. Metoclopramide could reduce spasms of the smooth muscle of the cervix , has a regulatory effect on cervical contractility and promoting cervical dilatation during labor. Objective: To determine whether Metoclopramide shortens the active phase of first stage of labor in Nulliparous women at term and reduces pain during this stage or not. Subject and Methods: A controlled, clinical trial between March 2022 to July 2022 was conducted, including a total of 100 pregnant women in active labor , they were randomly assigned into 2 groups; 50 women received an intravenous injection of 10 mg metoclopramide (Group 1) and 50 women received the same volume of placebo (0.9% sodium chloride) (Group 2). 2 (P- value < 0.001). The mean rate of cervical dilatation was 2.03 (cm/h) in group1 compared to 1.1(cm/h) in group 2. 19/50 (38%) women of group 1 needed oxytocin augmentation, while 35/50 (70%) women of group 2 needed oxytocin augmentation , which was highly statistically significant ( P-value <0.001). Regarding labor pain score using baseline visual analogue scale (VAS) and at 30, 60 and 120 minutes, the differences between both groups were not statistically significant ( P-value >0.001). Conclusion: This study showed that IV injection of Metoclopramide 10 mg every 2 hrs for a maximum of three doses help in reducing duration of active phase of first stage of labor with reducing the use of oxytocin in augmentation of labor.