Comparative evaluation of the caesarean section rate in term nulliparas with labour dystocia following augmentation with oxytocin alone versus with oxytocin and drotaverine

Abstract

Background: Labour dystocia is the commonest indication for emergency caesarean section in nulliparas, and occurs when the progress of labour is abnormally slow. Labour dystocia may be caused by abnormalities in uterine contractions, slow cervical dilatation, or mechanical disproportion between the foetal presenting part and the maternal pelvis. Augmentation of labour with oxytocin is the traditional management for labour dystocia as it enhances uterine contractions. At times, despite good uterine contractions, dystocia persists due to cervical smooth muscle spasms or mechanical factors, thereby increasing the caesarean section rate. Drotaverine is a musculotropic antispasmodic and can relieve smooth muscle spasms. Aim/objective: This study compared the caesarean section rate in term nulliparas with labour dystocia that were augmented with oxytocin and placebo versus with oxytocin and drotaverine Methods: This study was a single-blinded randomized clinical trial conducted between January and August 2021. It involved 156 term nulliparous women with labour dystocia that were randomized into two groups for augmentation of labour. Each group had 78 parturients that were managed with either oxytocin with a placebo or oxytocin with drotaverine. They were monitored till delivery and the caesarean section rate in both groups was compared. Data obtained were analysed with SPSS version 23 software. The level of significance was set at 0.05, P< 0.05 was statistically significant. Results: The two groups were similar in their sociodemographic characteristics. In this study 21(13.5%) women had emergency caesarean section while 135(86.5%) had vaginal delivery following augmentation. The caesarean section rate in the oxytocin-placebo was similar to the oxytocin-drotaverine group (10 (12.8%) vs 11 (14.1%), p=0.82). The majority, 14 (67%) of the caesarean sections were due to mechanical factors, 4 (19%) were due to functional dystocia and 3(14%) were due to foetal distress. Conclusion: The use of drotaverine with oxytocin in managing labour dystocia did not improve the caesarean section rate as the majority of the cases had mechanical dystocia.