EFFICACY OF DROTIN & EPIDOSIN IN CERVICAL DILATATION DURING LABOUR- ACOMPARATIVE STUDY

Background: Labour is a normal physiological process, progress of which depends upon the strength and frequency of uterine contractions and simultaneous active cervical dilatation. But sometimes active cervical dilatation lags behind even though there is presence of uterine contraction and causes pain abdomen, prolongation of labour which can hamper both maternal and foetal health. Hence comes the need to use the cervical dilators to encourage the cervical dilatation to compete with the frequent uterine contractions and facilitates the labour process. Valethamate Bromide (VB) belongs to those groups of drugs which can be used as a cervical dilator in need. Now a day, the use of VB has become very less in comparison with other cervical dilators and reason is not clearly established yet. Aim & Objectives: To Evaluate the acceleration effect of Drotin and Epidosin on the dilatation of the cervix in both primigravidae and multigravida and compare it with control group. To note the time interval between injection (of Drotin and Epidosin) and delivery and compare it with control group. To determine deleterious side effects if any of the drugs affecting either mother or foetus Methods/Study Design: It was an interventional, hospital based study done in Department of Obstetrics and Gynaecology Kasturba Hospital,BHEL,Bhopal from 2006 to 2007, India. After taking necessary permissions for the study, total 150 primi gravida patients without any obstetrical abnormality and contraindications to the drugs, were selected randomly for twelve months. Three equal (50 each) groups were formed to satisfy each objective separately. All of the drugs were given intramuscularly only in first stage of labour following the prescribed doses. Necessary clinical evaluations were done at a regular interval and collected data were analyzed with SPSS software. Results/Findings: Intramuscular administration of Drotaverine injection in the dilation phase of uncomplicated pregnancies significantly reduces the dilatation phase. It reduces the duration of active phase of labour by 30% in both primi.and multi group.Intramuscular administration of Epidosin reduces the duration -of active phase of labour in primi by 16% and in multi by 25%.Rate of cervical dilatation showed an increase of 0.23 cm/hr in primi Epidosin group and 0.519 cm/hr in primi Drotin group. Whereas in multi Epidosin group it was 0.44 cm/hr and 0.62 cm/hr in multi Drotin group as compared to control group. Thus the rate of cervical dilatation was maximum in Drotin group.As the number of injections required by patients in Drotin group was less as compared to Epidosin group, the cost effectiveness and patient compliance was increased with Drotin. Oxytocin augmentation required in Drotin and Epidosin group was in 8% and 6%. cases respectively as compared to 12% in Control group. Thus the drugs do not reduce the tone of uterine contractions rather cause normalising of irregular uterine contractions. Duration of second and third stage of labour were not affected by Drotin and Epidosin. Drotin did not reduce the uterine tone in the period following delivery.Apgar Score in Drotin group at 1 min and 5 min was 9.5 and 9.98 whereas in Epidosin it was 9.2 and 9.8 & in Control it was 9.12 and 9.8 respectively.Observing the Apgar Score can be concluded that the drugs do not interfere with uteroglacental circulation.Neonatal complication in all three groups were more or less equal.Epidosin had higher rate of side effects on mother as compared to Drotin. Tachycardia was seen in 12% cases, flushing of face in8% nausea and vomiting in 4% and dryness of month in 10% cases. Whereas only nausea and vomiting was seen in 8% cases of Drotin and one patient complained of dizziness. Incidence of PPH was equal in all three groups (4%) thus Drotin and Epidosin do not reduce the uterine tone in the period following delivery. None of the patients in Drotin group had cervical tear whereas 2 each in Epidosin and Control Group had Cervical Tear. Thus Drotin helps in reducing incidence of cervical tear. Drotin is a safer and convenient approach towards acceleration of labour. Maternal complications were also fewer in patients treated -with Drotin as compared to Epidosin. Study Limitations: It was single handed study done on small population and many clinical correlations were overlooked to focus the aims only. Conclusion: Leaving the contraindications in normal pregnancy with no abnormal obstetric problems Drotin is a safer and convenient approach towards acceleration of labour. Maternal complications were also fewer in patients treated -with Drotin as compared to Epidosin. Thus it can be concluded that Drotaverine is a new aid in the management of a convenient, shorter, physiological and uncomplicated delivery