To Evaluate the Efficacy of Drotavarine & Tramadol in all primigravida in providing safer shorter & relatively free delivery

Dr. .Meena N.Satia; Dr.Shweta Gupta; Dr Kimaya A Mali

Volume : V, Issue : V, May - 2016

To Evaluate the Efficacy of Drotavarine & Tramadol in all primigravida in providing safer shorter & relatively free delivery

Dr. . Meena N. Satia, Dr. Shweta Gupta, Dr Kimaya A Mali

Abstract :

Background: Normal labour composes of integration of the Three �P�s namely, 1.The �Powers� or driving forces provided by the uterine contractions,2.The �Passenger� or the fetus of optimum size and in favourable presentation and position.3. �Passages� or the birth canal composed of the soft tissues and the bony pelvis being adequate in capacity. Pain in labor is unpleasant and distressing to the patient. Pain relief during labour is very important as it allays fear and anxiety and provides a more favourable environment for improved obstetric outcome. This also helps in cervical dilation resulting in labours of shorter duration, less traumatic and requires lesser obstetric interventions. It helps prevent the undue muscular efforts of the mother which exhaust her . The objective of the current study is to evaluate the efficacy of drotavarine and tramadol in primigavidae to provide safer ,shorter and relatively pain free labour Methods In this study 200 primigravida patients admitted in labour at tertiary care hospital in Mumbai during period of 1 year from Dec 2011–Nov2012 were recruited .Primigravida with GA of 37–41 weeks with no obstetrical or medical complications.,.singleton pregnancy with cephalic presentation. & adequate pelvis were selected . Multigravide , Patients with abnormal presentation & cephalo–pelvic disproportion were excluded These 200 patients were equally divided in 2 groups by randomisation 1. Receiving injectable drotaverine and tramadol. 2. Not receiving any of two drugs. After entering active phase of labour i.e. 3cms of cervical diltation, partogram was plotted in all patients To optimise pain relief and facilitate cervical dilatation intramuscular tramadol in dose of 100mg along with intravenous drotaverine 40mgs 1hourly for three doses administered only in the study group. In the study group intravenous drotaverine was repeated 1hourly for maximum three doses and as duration of action of tramadol is 4–6 hours so single dose was sufficient. Results – Pain relief score of patients included in the study group was noted on rupees scale. RUPEES SCALE . Grade 1– No pain . Grade 2– Mild pain but comfortable–25% . Grade 3–Moderate pain with discomfort–50% Grade 4–Maximum pain/ Severe pain –75%or more Pain relief score, Duration of 1stand 2nd stage of labour. Mode of delivery. Neonatal Apgar at 1 and 5 mins. were the outcomes measured Conclusion There was statistically significant reduction in duration of 1st stage of labour in the study group as compared to the control group. However , there was no statistically significant difference in duration of 2nd stage of labour in both the groups. Overall 84% patients in the study group delivered within 6 hours whereas only 59% of the control group delivered within 6 hours.Majority of the patients in the study group had vaginal delivery as compared to the control group. After administration of tramadol none of the patients in the study group experienced severe pain ,majority of them had moderate pain relief. In the control group maximum patients experienced severe pain. With regard to neonatal outcome none of the baby from the study group had respiratory depression or required NICU admission. Only minor side effects were observed in 19% of cases.