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Gaudernack LC, Einarsen AES, Sørbye IK, Lukasse M, Gunnes N, Michelsen TM. The effect of intravenous hyoscine butylbromide on slow progress in labor (BUSCLAB): A double-blind randomized placebo-controlled trial. PLoS Med 2024; 21:e1004352. [PMID: 38547322 PMCID: PMC11008832 DOI: 10.1371/journal.pmed.1004352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 04/11/2024] [Accepted: 01/25/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Prolonged labor is a common condition associated with maternal and perinatal complications. The standard treatment with oxytocin for augmentation of labor increases the risk of adverse outcomes. Hyoscine butylbromide is a spasmolytic drug with few side effects shown to shorten labor when used in a general population of laboring women. However, research on its effect on preventing prolonged labor is lacking. We aimed to assess the effect of hyoscine butylbromide on the duration of labor in nulliparous women showing early signs of slow labor. METHODS AND FINDINGS In this double-blind randomized placebo-controlled trial, we included 249 nulliparous women at term with 1 fetus in cephalic presentation and spontaneous start of labor, showing early signs of prolonged labor by crossing the alert line of the World Health Organization (WHO) partograph. The trial was conducted at Oslo University Hospital in Norway from May 2019 to December 2021. One hundred and twenty-five participants were randomized to receive 1 ml hyoscine butylbromide (Buscopan) (20 mg/ml), while 124 received 1 ml sodium chloride intravenously. Randomization was computer-generated, with allocation concealment by opaque sequentially numbered sealed envelopes. The primary outcome was duration of labor from administration of the investigational medicinal product (IMP) to vaginal delivery, which was analyzed by Weibull regression to estimate the cause-specific hazard ratio (HR) of vaginal delivery between the 2 treatment groups, with associated 95% confidence interval (CI). A wide range of secondary maternal and perinatal outcomes were also evaluated. Time-to-event outcomes were analyzed by Weibull regression, whereas continuous and dichotomous outcomes were analyzed by median regression and logistic regression, respectively. All main analyses were based on the modified intention-to-treat (ITT) set of eligible women with signed informed consent receiving either of the 2 treatments. The follow-up period lasted during the postpartum hospital stay. All personnel, participants, and researchers were blinded to the treatment allocation. Median (mean) labor duration from IMP administration to vaginal delivery was 401 (440.8) min in the hyoscine butylbromide group versus 432.5 (453.6) min in the placebo group. We found no statistically significant association between IMP and duration of labor from IMP administration to vaginal delivery: cause-specific HR of 1.00 (95% CI [0.77, 1.29]; p = 0.993). Among 255 randomized women having received 1 dose of IMP, 169 women (66.3%) reported a mild adverse event: 75.2% in the hyoscine butylbromide group and 57.1% in the placebo group (Pearson's chi-square test: p = 0.002). More than half of eligible women were not included in the study because they did not wish to participate or were not included upon admission. The participants might have represented a selected group of women reducing the external validity of the study. CONCLUSIONS One intravenous dose of 20 mg hyoscine butylbromide was not found to be superior to placebo in preventing slow labor progress in a population of first-time mothers at risk of prolonged labor. Further research is warranted to answer whether increased and/or repeated doses of hyoscine butylbromide might have an effect on duration of labor. TRIAL REGISTRATION ClinicalTrials.gov (NCT03961165) EudraCT (2018-002338-19).
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Affiliation(s)
- Lise Christine Gaudernack
- Department of Obstetrics, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Angeline Elisabeth Styve Einarsen
- Department of Obstetrics, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingvil Krarup Sørbye
- Department of Obstetrics, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Mirjam Lukasse
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Campus Vestfold, Borre, Norway
| | - Nina Gunnes
- Norwegian Research Centre for Women’s Health, Oslo University Hospital, Oslo, Norway
| | - Trond Melbye Michelsen
- Department of Obstetrics, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Shabanian S, Danesh A, Najafi S. Investigating the Effect of Hyoscine and Dexamethasone on Cervical Preparation in Primigravid Women with Term Pregnancy: A Double-blind Randomized Clinical Trial. J Res Pharm Pract 2023; 12:130-134. [PMID: 39262410 PMCID: PMC11386062 DOI: 10.4103/jrpp.jrpp_41_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/02/2024] [Accepted: 05/03/2024] [Indexed: 09/13/2024] Open
Abstract
Objective Pregnancy outcomes are an important factor in women's quality of life, and negative experiences have adverse effects on the overall health of the mother and the family. This study was designed and implemented to compare the effects of two drugs, hyoscine and dexamethasone, on cervical ripening and effacement during childbirth. Methods This study was a double-blind randomized clinical trial of 150 patients divided into three groups. The researchers, in the early stage (latent) of labor, gave 8 mg of dexamethasone intravenously to the first group, 20 mg of hyoscine butyl bromide to the second group, and 8 mg of dexamethasone along with 20 mg of hyoscine butyl bromide to the third group. Findings Among the quantitative variables studied (length of labor induction, duration of active stage, first stage and second stage of labor, placental expulsion time, 5- and 10-min Apgar and Bishop score), active stage duration (P = 0.000) and 5-min Apgar (P = 0.042) had statistical differences among the three groups. In addition, the type of delivery (P = 0.003) and the percentage of fetal distress (P = 0.001) in the studied groups had a statistically significant difference, and also, in the third group, the cesarean rate was less than the other two groups. Conclusion Simultaneous injection of hyoscine and dexamethasone in primiparous women can reduce the duration of the active stage of labor without obstetric complications, so its use in the latent stage is suggested.
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Affiliation(s)
- Sheida Shabanian
- Department of Obstetrics and Gynecology, School of Medicine, Hajar Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Azar Danesh
- Department of Obstetrics and Gynecology, School of Medicine, Shahid Beheshti Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saba Najafi
- Department of Gynecology, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Abbas MS, Hassan SA, Abbas AM, Thabet AM, Thabet AM, Mahdy MM. Hemodynamic and antiemetic effects of prophylactic hyoscine butyl-bromide during cesarean section under spinal anesthesia: a randomized controlled trial. BMC Anesthesiol 2022; 22:112. [PMID: 35448942 PMCID: PMC9027476 DOI: 10.1186/s12871-022-01659-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 02/10/2022] [Indexed: 12/03/2022] Open
Abstract
Background Abrupt bradycardia and hemodynamic instability during spinal anesthesia for cesarean section are not uncommon and are considered as one of the primary causes of intraoperative nausea and vomiting (IONV). We hypothesized that prophylactic use of hyoscine butyl-bromide (HBB) could improve hemodynamics and reduce IONV in parturients undergoing cesarean section. Methods A randomized, double-blind placebo-controlled trial was carried out in a tertiary university hospital, patients scheduled for elective cesarean section were equally randomized to receive either IV HBB 20 mg in 1 ml (Hyoscine group) or the same volume of 0.9% saline (Control group), one minute after spinal anesthesia. The primary endpoint was the incidence of intraoperative bradycardia (HR < 50 beats min−1). Secondary endpoints included changes in mean arterial blood pressure (MAP), the incidence of Intraoperative and Postoperative nausea or vomiting (IONV & PONV), the fetal heart rate and, Apgar score. Results Of the 160 subjects randomized, 80 received HBB and 80 received placebo. There was a significant reduction in the incidence of the primary endpoint of intraoperative bradycardia (HR < 50 beats min−1) in the Hyoscine group (0% vs 10%; OR = 0.05, 95% CI = [0.003, 0.93]; P = 0.004) compared with placebo. MAP showed an insignificant difference between groups over time. HBB significantly decreased incidences of IONV and PONV (p = 0.002 & 0.004) respectively. Conclusions In parturients undergoing cesarean section under spinal anesthesia, pretreatment with intravenous HBB was a safe measure for both the mother and the baby to reduce the risk of severe intraoperative bradycardia, but not hypotension. Furthermore, it was associated with less incidence of both IONV and PONV. Trial registration https://clinicaltrials.gov/ct2/show/NCT04069078
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Affiliation(s)
- Mostafa Samy Abbas
- Anesthesia and Intensive Care department, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - Shimaa Abbas Hassan
- Anesthesia and Intensive Care department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed Mohamed Abbas
- Obstetrics and Gynaecology department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Amr Mohamed Thabet
- Anesthesia and Intensive Care department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed Mostafa Thabet
- Anesthesia and Intensive Care department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Magdy Mohammed Mahdy
- Anesthesia and Intensive Care department, Faculty of Medicine, Assiut University, Assiut, Egypt
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Maged AM, Sorour EH, ElSadek MM, Hassan SM, Shoab AY. A randomized controlled study of the effect of hyoscine butylbromide on duration of labor in primigravida women with prolonged labor. Arch Gynecol Obstet 2021; 304:1513-1518. [PMID: 33983512 DOI: 10.1007/s00404-021-06087-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the safety and efficacy of hyoscine butyl bromide (HBB) in primipara with prolonged 1st stage of labor. MATERIALS AND METHODS A double-blinded randomized controlled trial included 100 primiparas diagnosed with prolonged labor. They were randomly divided two equal groups. Group I received 40 mg HBB intravenously. Group II received 2 ml of normal saline. The primary outcome was the duration of the 1st stage of labor. Secondary outcomes included success of vaginal delivery, rate of cervical dilation, duration of 2nd and 3rd stages of labor, causes of CS, neonatal outcome and drug side effects. RESULTS The duration of the 1st stage was 322.3 ± 89.8 min in women who received HBB compared with 451.3 ± 198.3 min in the control women (P < 0.001). The rate of cervical dilation was increased from 0.4 ± 0.2 to 1.5 ± 0.6 in women who received HBB compared with its increase from 0.4 ± 0.1 to 0.9 ± 0.2 in other women (P < 0.001). The rate of CS were significantly higher in control women when compared to those received HBB (34 vs. 20%, P < 0.001). The commonest indication for the operation was arrest of cervical dilatation (28 and 16%, respectively). CONCLUSION HBB is associated with shortening of the 1st stage, lowered rate of CS without any side effects. CLINICAL TRIAL GOV ID NCT03430362 date of registration 6 February 2018. Synopsis Hyoscine butyl bromide is associated with shortening of the 1st stage, lowered rate of CS in primiparas with prolonged labor.
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Affiliation(s)
- Ahmed M Maged
- Obstetrics and Gynecology Department, Kasr AlAini Hospital Cairo University, 11 Eid Mostafa from King Faisal Street Haram Giza, Cairo, 12111, Egypt.
| | - Ehab H Sorour
- Obstetrics and Gynecology Department, Kasr AlAini Hospital Cairo University, 11 Eid Mostafa from King Faisal Street Haram Giza, Cairo, 12111, Egypt
| | - Mostafa M ElSadek
- Obstetrics and Gynecology Department, Kasr AlAini Hospital Cairo University, 11 Eid Mostafa from King Faisal Street Haram Giza, Cairo, 12111, Egypt
| | - Sarah M Hassan
- Obstetrics and Gynecology Department, Kasr AlAini Hospital Cairo University, 11 Eid Mostafa from King Faisal Street Haram Giza, Cairo, 12111, Egypt
| | - Amira Y Shoab
- Obstetrics and Gynecology Department, Kasr AlAini Hospital Cairo University, 11 Eid Mostafa from King Faisal Street Haram Giza, Cairo, 12111, Egypt
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Akiseku AK, Jagun OE, Akadri AA, Imaralu JO, Olatunji AO, Sule-Odu AO. Effect of hyoscine-N-butylbromide on labor duration among nullipara in a southwestern Nigerian teaching hospital: A randomized controlled trial. Int J Gynaecol Obstet 2020; 153:254-259. [PMID: 33113161 DOI: 10.1002/ijgo.13444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/23/2020] [Accepted: 10/26/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess the effectiveness of hyoscine-N-butylbromide on the duration of the first stage of labor among nulliparous women. METHODS A randomized double-blind placebo-controlled study among 126 nulliparous women admitted in the active phase of labor to a teaching hospital in Sagamu, Nigeria, from January to August 2018. Based on the inclusion criteria, women were recruited and randomized to the study or control group, and given intravenous hyoscine-N-butylbromide 20 mg (1 mL) or sterile water (1 mL), respectively, during the active phase. Labor progress and outcomes were compared between the groups. RESULTS The mean ± SD duration of active phase of first stage of labor was significantly shorter in the hyoscine-N-butylbromide group (324.9 ± 134.6 min) than in the control group (392.7 ± 119.6 min) (P = 0.004). The rate of cervical dilatation was 1.4 ± 0.8 cm/h in the hyoscine-N-butylbromide group and 1.0 ± 0.5 cm/h in the control group (P = 0.004). There were no significant differences in fetal heart rate, maternal vital signs, or Apgar scores between the two groups. CONCLUSION Hyoscine-N-butylbromide was found to be effective in shortening the duration of the first stage of labor without adverse outcomes for mother or neonate. The trial was registered with the Pan African Clinical trials Registry (PACTR), protocol number: PACTR201808146688942 (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3532).
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Affiliation(s)
- Adeniyi K Akiseku
- Department of Obstetrics and Gynaecology, Olabisi Onabanjo University, Ago Iwoye, Nigeria
| | - Olusoji E Jagun
- Department of Obstetrics and Gynaecology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
| | - Adebayo A Akadri
- Department of Obstetrics and Gynaecology, Babcock University Teaching Hospital, Ilishan-Remo, Nigeria
| | - John O Imaralu
- Department of Obstetrics and Gynaecology, Babcock University Teaching Hospital, Ilishan-Remo, Nigeria
| | - Adetola O Olatunji
- Department of Obstetrics and Gynaecology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
| | - Adewale O Sule-Odu
- Department of Obstetrics and Gynaecology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
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Mohaghegh Z, Abedi P, Faal S, Jahanfar S, Surdock A, Sharifipour F, Zahedian M. The effect of hyoscine n- butylbromide on labor progress: A systematic review. BMC Pregnancy Childbirth 2020; 20:291. [PMID: 32404072 PMCID: PMC7218842 DOI: 10.1186/s12884-020-2832-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 02/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background The objective of this systematic review and meta-analysis was to assess the effectiveness of hyoscine n-butylbromide in labor progress. Methods The databases including PubMed, the Cochrane Library, Science-Direct, Scopus and Web of Science were searched for studies published up to December 2019. Articles that published as randomized controlled trials (RCTs), and full-text articles published in English or other languages were included and participants were primi or multigravida women who were in active phase of labor. The intervention included HBB compared to placebo (normal saline) that was used during active phase of labor. Pooled estimates were measured using the fixed or random effect model, while the overall effect was reported in a mean difference (MD). All data were analyzed using Review Manager 5.3. Results Twenty studies involving 3108 women were included in meta-analysis. Based on subgroup analysis by parity, use of HBB significantly reduced the duration of the first stage of labor in primigravida women (MD = − 57.73; 95% CI: [− 61.48, − 53.60]) and in multigravida women (MD = − 90.74; 95% CI: [− 97.24, − 84.24]). Administering HBB could reduce the second stages of labor in primigravidas and multigravidas about 6 min and 4 min respectively. Also, HBB reduced the duration of the third stage of labor in multigravidas about 3 min. APGAR score at one and 5 min after birth was not affected. The main maternal adverse effect was tachycardia and dry mouth. Labor duration in studies in which the participants were primi-and multigravida was not presented based on separate parities except for four papers, and the route of HBB administration was not the same across all studies. Conclusions Although, the effect of HBB was minimal when multigravidas and primigravidas women were considered together, the HBB was clinically effective in primigravida and multigravida women for shortening the first and the second stages of labor. Also, HBB could reduce the length of the third stage of labor in multigravidas.
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Affiliation(s)
- Zaynab Mohaghegh
- Midwifery Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Parvin Abedi
- Midwifery Department, Menopause Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Shahla Faal
- Department of Midwifery, Islamic Azad University, Marand Branch, Marand, Iran
| | - Shayesteh Jahanfar
- School of Health Sciences-MPH Program Health Professions Building 2212, Central Michigan University, Mount Pleasant, USA
| | | | - Foruzan Sharifipour
- Midwifery Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Zahedian
- Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
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