Comparison of intravenous paracetamol infusion versus intramuscular tramadol as labor analgesia: a randomized control trial.

PURPOSE: Labor pain is one of the most agonizing pains experienced by all delivered women. Many pharmacological agents used in labor analgesia require intense monitoring facilities, which are not available in routine obstetric practice in low-resource settings. This study aimed to compare the efficacy of intravenous (IV) paracetamol and intramuscular (IM) tramadol on labor pain relief, labor progression, and maternal and neonatal outcomes. METHODS: This randomized drug trial was carried out on 110 women divided into two groups. Group A women received 1000 mg of IV paracetamol, and Group B women received 100 mg of IM tramadol during the active phase of labor. Pain intensity was assessed by the Visual Analogue Scale (VAS) at intervals till 120 min of delivery. The maternal and neonatal outcomes were recorded. RESULTS: There was a statistically significant fall in pain score till 180 min of drug administration in the paracetamol group and 120 min in the tramadol group. At 180 min and 240 min, paracetamol is more effective than tramadol (p value 0.004 at 180 min and 0.0119 at 240 min). There were significantly low pain score levels at 60 min of delivery in the paracetamol group (p value-0.004). Nausea and vomiting were significantly higher in the tramadol group (p value 0.000013). CONCLUSION: Compared to IM tramadol, IV paracetamol has a longer duration of action and fewer maternal side effects, making it suitable for parenteral analgesia in labor. Due to a better safety profile, there is no need for intense maternal and fetal monitoring with IV paracetamol. TRIAL REGISTRATION: Clinical Trials Registry-India (CTRI registration number-CTRI /2019/05/019244).

Effect of vaginal pH on efficacy of dinoprostone gel for labour induction: a cross-sectional study.

The purpose of this study was to assess the effect of vaginal pH on efficacy of intracervical dinoprostone gel (PGE2) for labour induction, progression and induction delivery interval. A cross-sectional study was done among 150 term pregnant women planned for induction with unfavourable Bishop's score ≤5. Women were categorised into two groups based on vaginal pH >4.5 and ≤4.5. Induction was done with maximum of three doses of PGE2 based on Bishop's score, followed by oxytocin administration. Failed induction rate was 14.5%. There was no significant association between vaginal pH and Bishop's score change after first gel application. There was no significant difference in failed induction rates, time from induction to active labour as well as induction delivery interval between two groups. Similarly, there was no significant association between oxytocin requirement and mode of delivery with vaginal pH. Intracervical PGE2 is an ideal route, unaffected by vaginal pH.Impact StatementWhat is already known on this subject? Prostaglandins are organic acids that have diminished solubility in aqueous solution with a low pH. The release of the drug could be altered by the acidity of vagina and this could result in variable clinical response. Vaginal pH may alter the efficacy of intravaginally administered prostaglandins through several potential mechanisms.What the results of this study add? There was no significant effect of change in vaginal pH on effectiveness of intracervical administered PGE2. There was no significant association between vaginal pH and time from induction to time women is entering into active labour as well as time from induction to delivery. Similarly, there was no significant association between mode of delivery and oxytocin usage with vaginal pH in labour. Intracervical PGE2 is an ideal route, unaffected by vaginal pH.What the implications are of these findings for clinical practice and/or further research? Further randomised studies are required comparing both vaginally administered PG inserts and intracervical PGE2 gels with vaginal and cervical pH, to directly compare their effectiveness in labour induction.

A comparison of fasting plasma glucose and glucose challenge test for screening of gestational diabetes mellitus.

Glucose challenge test (GCT) has been used as an effective screening test for gestational diabetes mellitus (GDM), though it has its own limitations. Hence, we assessed the effectiveness of fasting plasma glucose (FPG) as a simpler alternative procedure. A prospective study was done in 500 pregnant women with gestational age between 22 and 37 weeks. FPG, GCT and GTT were performed in all patients using the glucose oxidase/peroxidase method. The overall sensitivity and specificity of GCT were 75.0% and 92.0%, respectively and the corresponding values for FPG were 88.8% and 95.2%. The positive predictive value and negative predictive value were 42.2% and 97.9% for GCT and 59.2% and 99.1% for FPG, respectively. We conclude that FPG can be used as an effective screening tool for gestational diabetes mellitus.