Adjunctive use of propranolol in management of dystocia - Tips from Other Journals

Dysfunctional labor is implicated in approximately 60 percent of cesarean deliveries and is the major factor for the generally received high rates of operative delivery. Stimulation of beta receptors in the unruffled muscle of the genital tract causes a decrease in uterine tone and bring intos contractions. Theoretically, use of beta-blocking unsalable articles has a positive effect forward the mechanics of labor. Sanchez-Ramos and colleagues escorted a randomized, double-blind trial to evaluate intravenous propranolol as adjunctive therapy to oxytocin in the management of dysfunctional labor.

Women were included in the thought if they had arrest of dilation during active labor and if it was anticipated that they would deliver a singleton top infant weighing from 2,500 to 4500 g (5 lb 8 oz to 9 lb 15 oz) Exclusion criteria included maternal conditions of that kind as hypertension, tachycardia, bradycardia, asthma and diabetes. Of the 96 patients chronicleed in the study, 49 were randomly rareed to receive 2 mg of intravenous propranolol during oxytocin therapy. The remaining 47 patients received identical placebo. If necessary, placebo or propranolol was repeated after undivided hour. Patients who did not correspond to the second dose underwent cesarean delivery. Monitoring of the pair mother and fetus was carried public throughout the delivery. The sum of two units groups of patients were comparable in age, race, gravidity, parity, gestation, and maternal weight and height.

In the placebo-treated collection 24 patients (51 percent) underwent cesarean section, compared with 13 patients (27 percent) treated with propranolol. This difference was significant and was sustained when data were analyzed controlling for parity, birth weight and use of epidural anesthesia. No significant differences were originate between the two treatment arranges in maternal morbidity or measures of fetal well-being in the same state [i]or[/i] condition as mean birth weight, Apgar score, rate of admission to the neonatal intensive care unit or cord arterial line pH values.

The authors infer that low-dose propranolol administered intravenously during oxytocin treatment of dysfunctional labor significantly reduc the rate of cesarean deliveries.

Sanchez-Ramos L et al. Randomized trial of oxytocin alone and with propranolol in the management of dysfunctional labor. Obstet Gynecol 1996;88:517-20

COPYRIGHT 1997 American Academy of Family Physicians

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