Active management of labor in a low‐resource setting and its impact on cesarean section rates

Abstract

Labor and delivery-related complications being the largest contributors to India's high maternal mortality rate, optimizing labor and delivery are of utmost importance. This study analyses the safety and efficacy of active management of labor at a secondary hospital using the protocol proposed by Daftary [1].Women in labor with a term pregnancy who consented to the protocol formed the study group. The control group was managed expectantly. The 2 groups of 700 participants each were similar regarding parity, age, and pregnancy-related complications such as pregnancy-induced hypertension, intrauterine growth retardation, and postdatism.A gel preparation containing 0.5 mg of prostaglandin E2 was instilled intracervically in women with a Bishop score of 6 or less, and oxytocin was administered for labor augmentation if necessary. The partogram was then started, and amniotomy performed [2]. At the onset of the active phase of labor, 6 mg of pentazocin (an opioid analgesic) and 2 mg of diazepam (a tranquilizer) were diluted in distilled water and administered intravenously, and 50 mg of camylofin dihydrochloride (a smoothmuscle relaxant) was administered intramuscularly. Three hours later an injection of tramadol hydrochloride (an analgesic) or drotaverine hydrochloride (an antispasmodic) was given, the latter being repeated every 2 h depending on the partogram and the patient's pain score. An injection of 125 mg of carboprost tromethamine was given intramuscularly after delivery to promote contraction and retraction of the uterine musculature. The remainder of the pentazocine and diazepam mixture was injected while the episiotomy was being sutured. The pain score was tabulated, and the total duration of labor and labor outcomes were analyzed. P b.05 was considered significant in determining the effect of active management of labor on the rate of cesarean deliveries. An attempt was made to identify the indications that could benefit from this protocol.

Camylofin dihydrochloride injection: a drug monograph review

“…Here it is given along with an analgesic agent like tramadol, as the combined drug effect is considered to provide good analgesia, in addition to improving the cervical dilatation. 11,12 Camylofin injection can be used for augmentation of labor in both primigravida and multigravida women. Camylofin shortens the duration of labor in primigravidas by almost 40% and multigravidas by almost 24%.…”

“…Driscoll et al reported on the advantages of active management of labor resulting in shorter labor, improved obstetric outcome and lowered cesarean section rates. 11,12,20…”

“…Programmed labor is an indigenously developed protocol for labor management (Daftary et al 1977), developed with the dual objective of providing pain relief during labor and reaching the goals of safe motherhood by optimizing obstetric outcome. 11,12 Programmed labor concept…”

“…The protocol developed by Daftary et al, over a period of many years rests on three pillars of 11,12…”

Role of camylofin and its combinations in obstetrics and gynaecological practice: a review of Indian evidence

“…3 In obstetric practice it not only hastens cervical dilatation for augmentation of labor, but also provides enhanced analgesia when given along drugs like tramadol. 4,5,6 Camylofin has been available in India since 1958. 7 Ever since, the drug has traversed almost six decades of clinical use and continues to be a preferred antispasmodic for a variety of spasmodic pains of abdominal origin.…”