The Effect of Metoclopramide on the Length of First Stage of Labor and on Labor Pain in Nulliparous Women, A Randomized Controlled Trial

Background: Prolonged labor can lead to increased maternal and neonatal morbidity and mortality. The two main factors
that determine duration of labor are cervical dilatation and effacement . Several studies showed that active management of labor could shorten the duration of labor through mechanical, pharmacological and non-pharmacological factors that can increase cervical dilatation. Metoclopramide could reduce spasms of the smooth muscle of the cervix , has a regulatory effect on cervical contractility and promoting cervical dilatation during labor.
Objective: To determine whether Metoclopramide shortens the active phase of first stage of labor in Nulliparous women at
term and reduces pain during this stage or not.  Subject and Methods: A controlled, clinical trial between March 2022 to July 2022 was conducted, including a total of 100 pregnant women in active labor , they were randomly assigned into 2 groups; 50 women received an intravenous injection of 10 mg metoclopramide (Group 1) and 50 women received the same volume of placebo (0.9% sodium chloride) (Group 2).  Results: Regarding the duration of second stage of labor, the difference was not statistically significant (p-value > 0.001). On the other hand, there was significant difference regarding duration of active phase of first stage of labor (p-value < 0.001). The mean duration of active phase in group 1 was (145.8 minutes) compared to (263.6minutes) in group 2, the duration from admission until full cervical dilatation was shortened by 117.8 minutes. The rate of cervical dilatation was significantly higher in group 1 compared to group 2 (P- value < 0.001). The mean rate of cervical dilatation was 2.03 (cm/h) in group1 compared to 1.1(cm/h) in group 2. 19/50 (38%) women of group 1 needed oxytocin augmentation, while 35/50 (70%) women of group 2 needed oxytocin augmentation , which was highly statistically significant (P-value <0.001). Regarding labor pain score
using baseline visual analogue scale (VAS) and at 30, 60 and 120 minutes, the differences between both groups were not
statistically significant (P-value >0.001).  Conclusion: This study showed that IV injection of Metoclopramide 10 mg every 2 hrs for a maximum of three doses help in reducing duration of active phase of first stage of labor with reducing the use of oxytocin in augmentation of labor.