Effect Of Intra-muscular Administration of Dexamethasone in Induction of Labour

Effect Of Intra-muscular Administration of Dexamethasone on the Duration of Induction of Labour in Primigravida Post-term Pregnancy.

ABSTRACT:

Objective: To evaluate the efficacy of dexamethasone on labor duration and to establish whether dexamethasone plays a role in shorting the duration interval between initiation of labor induction and beginning of the active phase in primigravida full-term pregnancy.

Methods: case control study included 86 primigravidae with full term pregnancy classified into two groups: The participant of Group I will receive a prefilled syringe with two milliliters (8 mg) of Dexamethasone intramuscular, and the participants of Group II will not receive Dexamethasone or any other cervical ripening agent.

Key Words: Dexamethasone;post-term pregnancy;induction of labor.

Study Overview

• Status: Unknown
• Conditions: Medical Induction of Labor Affecting Fetus
• Intervention / Treatment: Drug: Dexamethasone; Drug: Placebo

Detailed Description

METHODS:

This retrospective clinical trial was conducted at the Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, during the period from August 2014 to May 2015. The study protocol was approved by the Scientific Research Committee, and informed consent was obtained from all participants.

Each participant will randomly be assigned by computer list into Group I (Dexamethasone group(n=43)and group II(control group(N=43).

No cervical ripening agent will be used for induction of labour in the trial.

Methodology in details:

I. The participant of Dexamethasone Group will receive a prefilled syringe with two milliliters (8 mg) of Dexamethasone intramuscular, and the participants of placebo Group will not receive Dexamethasone or any other cervical ripening agent.

All the participants in both groups will randomly be assigned by computer list. (Haijavandi et., al 2013)

II. After six hours of the initial dose, the labour induction will start via Oxytocin using the following protocol:

1. Initial dose of oxytocin.................................. 1 to 2 milliliter international unit/min.
2. Increase interval......................................................30 minutes.
3. Dosage increment....................................................1 to 2 milliliter international unit/min.
4. Usual dose for good labour.........................8 to12 milliliter international unit/min.
5. Maximum dose…………………...................30 milliliter international unit/min. (Anne Biringer et., al 2013).

III. The interval between the initiation of induction and the beginning of the active phase of labour is recorded (a cervical dilatation of 4 cm plus 3 forceful contractions over a 10-minute span each last from 40-60 Sec).

IV. Partographic representation for progression of active phase labour:

1. Frequency and duration of uterine contraction.
2. Cervical dilatation will record every two hours by per vaginal examination.
3. Station and position of fetal head was noted at the same time.

V. After delivery:-

1. The duration of the first stage of labor will be recorded. (Partographic representation will do for each participant).
2. The duration of the second stage of labor will be recorded.
3. The duration of the placental separation will be recorded.
4. The neonatal outcome will be recorded by APGAR score.
5. Any postpartum maternal adverse effect was noted (e.g. vital sign abnormality, any maternal postpartum hemorrhage).

Primary outcome:

the duration between induction and beginning of active phase.

Secondary outcome:

-Duration of first stage.

• Study Type: Interventional
• Enrollment (Anticipated): 86
• Phase: Phase 4

Contacts and Locations

Study Locations

• Egypt
  • Cairo, Egypt, 12345
    • Mohamed Abdel Aziz El Sharkawy

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 35 years (Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• Singleton pregnancy.
• Primigravida.
• Post-term gestation i.e. 41 weeks or more.
• Sure, reliable dates.
• Favorable cervix with Bishop score of 7 or greater.
• Longitudinal lie.
• Cephalic presentation (Vertex).

Exclusion Criteria:

• Abnormal presentation.
• Multigravida.
• Multiple pregnancies.
• Active phase of labour.
• Cephalo-pelvic disproportion.
• History of any medical disorder.
• History of previous myomectomy operation.
• Known contraindication or hypersensitivity to Dexamethasone.
• Current fetal distress.
• Current maternal or fetal disorder e.g. Diabetes mellitus; Pregnancy induced hypertension, and fetal growth retardation.
• Over distended abdomen e.g. fetal macrosomia or polyhydramnios suggested by ultrasound or estimated fetal weight by expert hand.
• Significant vaginal bleeding.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: dexamethasone group; The participant of Dexamethasone Group will receive a prefilled syringe with two milliliters (8 mg) of Dexamethasone intramuscular After six hours of the initial dose, the labour induction will start via Oxytocin .III. The interval between the initiation of induction and the beginning of the active phase of labour is recorded (a cervical dilatation of 4 cm plus 3 forceful contractions over a 10-minute span each last from 40-60 Sec).	Drug: Dexamethasone; The participant of Dexamethasone Group will receive a prefilled syringe with two milliliters (8 mg) of Dexamethasone intramuscular, and the participants of Group II will not receive Dexamethasone or any other cervical ripening agent. All the participants in both groups will randomly be assigned by computer list. II. After six hours of the initial dose, the labour induction will start via Oxytocin using; Other Names: epidrone
Placebo Comparator: Placebo group; and the participants of placebo Group will not receive Dexamethasone or any other cervical ripening agent.II.two milliliters of normal saline given.	Drug: Placebo; two milliliters of normal saline given to placebo group .; Other Names: Normal saline

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
the duration between induction and beginning of active phase.	6 months

Secondary Outcome Measures

Outcome Measure	Time Frame
Duration of first stage.	7 months

Collaborators and Investigators

• Sponsor: Kasr El Aini Hospital

Study record dates

Study Major Dates

• Study Start: September 1, 2015
• Primary Completion (Anticipated): July 1, 2016
• Study Completion (Anticipated): July 1, 2016

Study Registration Dates

• First Submitted: July 14, 2015
• First Submitted That Met QC Criteria: July 23, 2015
• First Posted (Estimate): July 24, 2015

Study Record Updates

• Last Update Posted (Estimate): February 1, 2016
• Last Update Submitted That Met QC Criteria: January 29, 2016
• Last Verified: September 1, 2015

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Physiological Effects of Drugs; Autonomic Agents; Peripheral Nervous System Agents; Anti-Inflammatory Agents; Antineoplastic Agents; Antiemetics; Gastrointestinal Agents; Glucocorticoids; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Antineoplastic Agents, Hormonal; Dexamethasone
• Other Study ID Numbers: KasrELAiniH