The effects of topical magnesium sulfate on progression of effacement, dilatation and duration of labor in nulliparous women

Document Type : Original Article

Authors

1 M.Sc. student of Midwifery, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Associate Professor, Department of Midwifery and Reproductive Health, Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

3 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

4 PhD student of Biostatistics, School of Paramedicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Introduction: Effacement and dilatation are important factors affecting the progress and duration of labor. Impairment in their progression can disrupt the normal progress of labor and lead to maternal and neonatal complications. For many years, topical magnesium sulfate has been used experimentally for labor progression in Iran. Therefore, this study was performed with aim to determine the effects of topical magnesium sulfate on progression of effacement, dilatation and duration of labor in nulliparous women.
Methods: This double-blind randomized clinical trial was conducted on 72 nulliparous women with term pregnancy that had referred to Tehran Mahdieh hospital for delivery from March 2016 to September 2017. The participants were randomly divided into two groups of magnesium sulfate and placebo (n=36 in each group). In the magnesium sulfate group (intervention), 10 cc of magnesium sulfate 50%, and in the control group, 10 cc of distilled water was poured on the cervix in the beginning of the active phase, and the labor progress was assessed in two groups. Data were analyzed by SPSS software (version 17) and using independent t-test, Mann-Whitney, Chi-square and Fisher's exact tests. P<0.05 was considered statistically significant.
Results: Mean duration of active phase of first stage of labor was 1.75±1.13 hours in magnesium sulfate group and 3.85±1.87 hours in placebo group, that was 2.10 hours longer than magnesium sulfate group (P=0.001). The drop-in hemoglobin levels was significantly lower in magnesium sulfate group than in the control group (P=0.022). The number of normal vaginal delivery was higher in magnesium sulfate group, but this difference was not statistically significant (P=0.429). There were no significant differences between two groups in terms of neonatal Apgar score, ruptures in birth canal and the mother’s postpartum conditions (p>0.05).
Conclusion: The use of topical magnesium sulfate on the cervix in the active phase improves effacement and dilatation and shortens the duration of labor. Since there are very few studies on this subject, performing further studies are recommended.

Keywords

References

  1. Cunningham F, Leveno K, Bloom S, Spong CY, Dashe J. Williams obstetrics. 24th ed. New York: McGraw-Hill; 2014.
  2. Zhu BP, Grigorescu V, Le T, Lin M, Copeland G, Barone M, et al. Labor dystocia and its association with interpregnancy interval. Am J Obstet Gynecol 2006; 195(1):121-8.
  3. Kjaergaard H, Olsen J, Ottesen B, Dykes AK. Incidence and outcomes of dystocia in the active phase of labor in term nulliparous women with spontaneous labor onset. Acta Obstet Gynecol Scand 2009; 88(4):402-7.
  4. Gifford DS, Morton SC, Fiske M, Keesey J, Keeler E, Kahn KL. Lack of progress in labor as a reason for cesarean. Obstet Gynecol 2000; 95(4):589-95.
  5. Samei-zadeh T. Effect of relative presence at bedside of primiparous woman on labor duration. [Doctoral Dissertation]. Mashhad: Mashhad School of Nursing and Midwifery; 1999. (Persian).
  6. Berg TG, Rayburn WF. Effects of analgesia on labor. Clin Obstet Gynecol 1992; 35(3):457-63.
  7. World Health Organization. Population divison. Womens health and safe mother hood. Genove: World Health Organization; 1996. P. 18-23.
  8. Grobman WA, Bailit J, Lai Y, Reddy UM, Wapner RJ, Varner MW, et al. Association of the duration of active pushing with obstetric outcomes. Obstet Gynecol 2016; 127(4):667-73.
  9. Stephansson O, Sandstrom A, Petersson G, Wikstrom AK, Cnattingius S. Prolonged second stage of labour, maternal infectious disease, urinary retention and other complications in the early postpartum period. BJOG 2016; 123(4):608-16.
  10. Cohen WR, Friedman EA. Misguided guidelines for managing labor. Am J Obstet Gynecol 2015; 212(6):753.e.1-3.
  11. Laughon SK, Berghella V, Reddy UM, Sundaram R, Lu Z, Hoffman MK. Neonatal and maternal outcomes with prolonged second stage of labor. Obstet Gynecol 2014; 124(1):57-67.
  12. Leveno KJ, Nelson DB, McIntire DD. Second-stage labor: how long is too long? Am J Obstet Gynecol 2016; 214(4):484-9.
  13. Zhang J, Landy HJ, Branch DW, Burkman R, Haberman S, Gregory KD, et al. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstet Gynecol 2010; 116(6):1281-7.
  14. Protraction labor. UpToDate. Available at: URL: http://www.uptodate.com; 2016
  15. Vogel JP, West HM, Dowswell T. Titrated oral misoprostol for augmenting labour to improve maternal and neonatal outcomes. Cochrane Database Syst Rev 2013; 9:Cd010648.
  16. Tabarraei Y, Dargahi R, Azari M, Mard A, Rahimi G, Refahi S. The effect of intravenous injection of Atropine with hyoscine on the progress of labor in primiparous women in Alavi hospital, Ardabil, Iran. Life Sci J 2013; 10(5):649-51.
  17. Khoddam R. Pocket guide to Iran generic drugs. Tehran: Dibaj; 2007. P. 1176.
  18. Klein M. AHFS drug information. America: American Society of Health-System Pharmacists; 2010. P. 3824.
  19. Guyton AC, Hall JE. Textbook of medical physiology. 13th ed. New York: Elsiever Saunders; 2016. P. 641.
  20. Izzo AA, Gaginella TS, Capasso F. The osmotic and intrinsic mechanisms of the pharmacological laxative action of oral high doses of magnesium sulphate. Importance of the release of digestive polypeptides and nitric oxide. Magnes Res 1996; 9(2):133-8.
  21. Ikarashi N, Mochiduki T, Takasaki A, Ushiki T, Baba K, Ishii M, et al. A mechanism by which the osmotic laxative magnesium sulphate increases the intestinal aquaporin 3 expression in HT-29 cells. Life Sci 2011; 88(3-4):194-200.
  22. Markos D, Bogale D. Knowledge and utilization of partograph among health care professionals in public health institutions of Bale zone, Southeast Ethiopia. Public Health 2016; 137:162-8.
  23. Laughon SK, Zhang J, Troendle J, Sun L, Reddy UM. Using a simplified Bishop score to predict vaginal delivery. Obstet Gynecol 2011; 117(4):805-11. 
  24. Nicolaides KH, Welch CC, Koullapis EN, Filshie GM. Cervical dilatation by Lamicel--studies on the mechanism of action. Br J Obstet Gynaecol 1983; 90(11):1060-4. 
  25. Berkus MD, Laufe LE, Castillo M. Lamicel for induction of labor. J Reprod Med 1990; 35(3):219-21. 
  26. Cahill DJ, Clark HS, Martin DH. Cervical ripening: the comparative effectiveness of Lamicel and prostaglandin E2 tablets. Irish J Med Sci 1988; 157(4):113-4.
  27. Radestad A, Christensen NJ. Magnesium sulphate and cervical ripening (a biomechanical double-blind, randomized comparison between a synthetic polyvinyl sponge with and without magnesium sulphate). Contraception 1989; 39(3):253-63.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 22, Issue 8
October 2019
Pages 44-51

Files

Share

How to cite

Statistics