Effect of hyoscine butylbromide on cervical dilation during labor

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"apellidos" => "Díaz-Olachea" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665579614000076?idApp=UINPBA00004N" "url" => "/16655796/0000001700000066/v1_201508210029/S1665579614000076/v1_201508210029/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1665579614000064" "issn" => "16655796" "doi" => "10.1016/j.rmu.2014.09.002" "estado" => "S300" "fechaPublicacion" => "2015-01-01" "aid" => "5" "copyright" => "Universidad Autónoma de Nuevo León" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Medicina Universitaria. 2015;17:20-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1316 "formatos" => array:3 [ "EPUB" => 35 "HTML" => 896 "PDF" => 385 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Variables related to sexual prejudice among Mexican health science students" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "20" "paginaFinal" => "29" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Moral-de la Rubia, A. Valle-de la O, C.H. García-Cadena" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Moral-de la Rubia" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Valle-de la O" ] 2 => array:2 [ "nombre" => "C.H." "apellidos" => "García-Cadena" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665579614000064?idApp=UINPBA00004N" "url" => "/16655796/0000001700000066/v1_201508210029/S1665579614000064/v1_201508210029/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Effect of hyoscine butylbromide on cervical dilation during labor" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "30" "paginaFinal" => "33" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "E.M. Treviño-Salinas, G.E. Castillo-Martín del Campo, C. Ayuzo-del Valle, A. Guzmán-López, J.A. Soria-López, J.L. Iglesias-Benavides, R. Ambriz-López" "autores" => array:7 [ 0 => array:4 [ "nombre" => "E.M." "apellidos" => "Treviño-Salinas" "email" => array:1 [ 0 => "trevinoemilio@yahoo.com.mx" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "G.E." "apellidos" => "Castillo-Martín del Campo" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Ayuzo-del Valle" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Guzmán-López" ] 4 => array:2 [ "nombre" => "J.A." "apellidos" => "Soria-López" ] 5 => array:2 [ "nombre" => "J.L." "apellidos" => "Iglesias-Benavides" ] 6 => array:2 [ "nombre" => "R." "apellidos" => "Ambriz-López" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Gynecology and Obstetrics of the “Dr. José Eleuterio González” University Hospital of the Autonomous University of Nuevo León, Mexico" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Departamento de Ginecología y Obstetricia del Hospital Universitario “Dr. José Eleuterio González” de la UANL. Av. Madero y Gonzalitos, Col. Mitras centro sin número, C.P. 64460 Monterrey Nuevo León, México. Tel.: +52 81 8389 1111; Mobile: +52 81 81622126." ] ] ] ] "textoCompleto" => "IntroductionLabor is a sequential physiological event. It integrates changes that will take place in the myometrium, decidua and cervix, which occur over a period of days, or even weeks. Biochemical changes appear before the onset of uterine contractions and cervical dilatation.<a class="elsevierStyleCrossRef" href="#bib0060">1</a> Labor at term, supposes the liberation of inhibitor factors which affect pregnancy and the myometrium, which sets off an active process through uterine stimulators.<a class="elsevierStyleCrossRef" href="#bib0065">2</a> Different substances intervene during labor, like prostaglandins (PG), estrogens and oxytocin, among others.It was customary to follow the natural evolution of labor without the application of any method to accelerate it (passive handling of labor), either that or with the use of medications which accelerate it (active handling of labor).<a class="elsevierStyleCrossRef" href="#bib0065">2</a>In the beginning of the 20th century, in 1906, the first uterotonic was discovered, oxytocin. It was not until 1911 when its implementation began to accelerate labor.<a class="elsevierStyleCrossRef" href="#bib0065">2</a> Oxytocin is a cyclic nonapeptide obtained through chemical synthesis. Its synthetic form is identical to that of a hormone stored in the posterior hypophysis, it stimulates the smooth muscle of the uterine strongly toward the end of the pregnancy, during labor and immediately after childbirth. During this phase, oxytocin receptors in the myometrium increase. This is a fast-acting hormone, with a latent period of under a minute after intravenous application and between 2 and 4min after intramuscular injection.<a class="elsevierStyleCrossRef" href="#bib0070">3</a> In the active phase of the first period of labor, oxytocin is commonly used, in patients who require it in order to cause uterine contractions and to regularize its frequency.<a class="elsevierStyleCrossRef" href="#bib0075">4</a>In some countries, in addition to the above, other medications have been used to shorten labor, such as drotaverin and hyoscine N-butylbromide (BBH).<a class="elsevierStyleCrossRef" href="#bib0075">4</a> This is part of a group of scopolamine derivates, which are muscarinic antagonists and have antispasmodic effects. It inhibits cholinergic activity in abdominal and pelvis parasympathetic lymph nodes, having an effect on the smooth muscle of the digestive tract, urinary, biliary, female sexual organ and especially over the uterine–cervical plexus,<a class="elsevierStyleCrossRef" href="#bib0080">5</a> which explains its effect in cervical dilatation. However, this has not yet been clearly stated.<a class="elsevierStyleCrossRef" href="#bib0085">6</a>This medication does not have effects over uterine contractibility; it does not go through the blood–brain barrier and its fixation to proteins is very low, with a very quick distribution; after intravenous administration the time of action is around 10min, with a peak from 20 to 60min and an average life ranging from 4 to 5h.<a class="elsevierStyleCrossRef" href="#bib0090">7</a> Its main way of excretion is renal. No adverse effects during pregnancy or lactation have been proven; however, its use is recommended with caution under the first trimester. Side effects include: dry mouth, facial flushing, intermittent loss of accommodation reflexes, urinary retention and constipation.<a class="elsevierStyleCrossRef" href="#bib0085">6</a>There have been few studies in which the use of BBH was evaluated to shorten labor. These have reported the reduction of labor time compared to the control group which received placebo,<a class="elsevierStyleCrossRef" href="#bib0080">5</a> and one study compared its effectiveness versus oxytocin.<a class="elsevierStyleCrossRef" href="#bib0095">8</a> The objective of our study was to compare the efficacy and safety of BBH versus placebo during labor.Materials and methodsA randomized experimental study was designed in which patients older than 18 years were included, with a term pregnancy (37–42 weeks), independent from the parity with cephalic presentation, with a clinically adequate pelvis for labor, where there was no evidence of macrosomia (estimated fetal weight over 4000g) and who were in the first period of labor in the active phase (dilatation of 4cm or more) with regular uterine activity (3–4 contractions in 10min). We excluded all patients who needed to complete childbirth abdominally due to different causes.Patients who were eligible for this study were chosen randomly to receive active treatment with BBH versus a placebo using a sampling of two proportions, in an infinite population, with a potency of 90% to detect the difference of 30% among the study groups; a statistically significant level of 0.05 was established. Over these premises a sample size of 40 patients per group was calculated.The study included a total of 86 women who met the inclusion criteria and who went to the Emergency Service of the “Dr. José E. González” University Hospital for the resolution of their pregnancy between June 2009 and July 2010. All patients signed an informed consent.The patients were randomly distributed into one of the two groups: the cases group, with 43 patients who were administered 20mg of BBH (diluted in 9ml of saline solution) intravenously on two occasions with an interval of 1h, and the control group with 43 patients who were administered a placebo (10ml of saline solution) at a similar dosage and interval. After every dose, fetal and maternal cardiac frequency monitoring was performed and patients were questioned about side effects. Labor progress was evaluated in a conventional manner, monitoring the time of every period of labor, in addition to the events occurring during its evolution (spontaneous rupture of membranes, analgesia, forceps application, etc.). Also weight at birth, Apgar and Capurro were evaluated. Maternal and fetal complications were evaluated (uterine atony, vaginal and perineal tears, etc.) after childbirth. Central tendency measurements were utilized and the duration of every period of labor was determined.The differences between groups were compared with χ2 or Fisher's exact test in the case of categorical variables and with the Student's t-test for continuous variables.ResultsA total of 90 patients were included in the study. Of these, we discarded two patients from the case group and two from the control group, because it became necessary for them to have an abdominal birth. The cervical conditions of the placebo group upon entry were: dilation of 5.6±1.5cm, 73±11% effacement and Bishop Index of 8.8±1.2. And in the BBH group they were: dilation of 5.2±1.3cm, 72±11% effacement and Bishop Index of 8.6±1.2. Upon comparison of these variables, there was no statistically significant difference, which indicates that these two groups were homogenous (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Regarding the results of the duration of labor, the first period of labor, evaluated in minutes, was 139.93±92.4 in the placebo group versus 151.186±84.6 in the BBH group (p=NS). The second period of labor had a duration of 15.5±9.33min in the first group and 13.18±6.35min in the second (p=NS). Finally, the third period registered a time of 6.4±3.2min in the placebo group and 6.5±3.7min in the BBH group. We were unable to find a statistically significant difference (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Upon separating the groups by number of pregnancies, we found that the BBH group had a 159.1±84min time for the first phase of labor, with significant difference of p=0.002 compared to the control group (262.5±92min).Concerning the perinatal results, we observed a fetal weight of 3248±374g, a length of 50.7±1.9cm and 39.14±1.2 Capurro weeks in the placebo group, and a fetal weight of 3185.5±397g, a length of 50.7±1.7cm and 38.9±1.1 Capurro weeks in the BBH group. We were unable to find a statistically significant difference. Concerning the condition of the babies immediately after birth, we reported an Apgar score at the first minute of 8.2±0.6 and 9.1±0.4 at 5min in the control group, and 8.2±0.4 at the first minute and 9±0 at 5min in the BBH group. We were unable to find a statistically significant difference (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>DiscussionPrevious studies performed with BBH have reported results which vary from no difference in cervical dilation time to decreases greater than 2h. Aggarwal et al.<a class="elsevierStyleCrossRef" href="#bib0090">7</a> performed a study in which they found that in addition to a 35.6% diminishment in the perception of pain during labor due to the use of intravenous BBH, the first period of labor was reduced in a significant way, from 8h 16min in the control group, to 3h 46min in the BBH group. Samals et al. concluded that using intravenous BBH, at a dose of 20mg, was able to diminish the effort of labor by up to 32%.<a class="elsevierStyleCrossRef" href="#bib0100">9</a>Other authors recently compared the use of this pharmaceutic to oxytocin without finding a statistically significant difference in the effort of labor,<a class="elsevierStyleCrossRef" href="#bib0105">10</a> which is the reason the use of this medication should be considered as an option for primigravid patients which, for whatever reason, cannot receive oxytocin.We can make a recommendation for the use of this pharmaceutic in patients with the results obtained by separately evaluating groups of primigravid and multigravid patients which received BBH vs. a placebo; with regard to the multiparous, there was no significant difference found between any of the groups.Just like in other studies,<a class="elsevierStyleCrossRef" href="#bib0110">11</a> our results show no adverse effects on the fetus, which were evaluated by the APGAR at 1 and 5min.ConclusionsBased on the results obtained in our investigation, we can conclude that although we were not able to prove a statistically significant decrease in the effort of labor in both groups, we did demonstrate that when the groups of primigravidas and multigravidas are compared separately, the primigravida BBH group showed a statistically significant difference, with a p of 0.002.Based on the previous studies, we can make a recommendation for the use of BBH in primigravid patients, also demonstrating that the administration of this product is safe during pregnancy, since there were no adverse effects presented during its administration, or among the babies in all the studied population.Conflict of interestThe authors have no conflicts of interest to declare.FundingNo financial support was provided." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres542832" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec562181" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Funding" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-06-05" "fechaAceptado" => "2014-11-25" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec562181" "palabras" => array:3 [ 0 => "Labor" 1 => "Obstetrics" 2 => "Oxytocics" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo compare the effects of intravenous hyoscine butylbromide versus placebo on the duration of labor in term pregnancies. Materials and methods86 patients were selected and randomly assigned to receive intravenous hyoscine butylbromide (20mg twice) (n=43) or an intravenous placebo (saline solution 10cc) (n=43). We evaluated maternal adverse effects, effects on neonatal Apgar score, cervical dilatation 1h after drug administration and the interval between the onset of labor and delivery. ResultsNo significant differences were observed in the duration of phases of labor between the two groups. No significant differences were found between the groups in Apgar scores at 1 and 5min. No maternal adverse effects were observed or reported due to the use of hyoscine butylbromide or the placebo. On the first phase of primigravidas it shortens the first labor phase up to 159.1±84min vs. the control group (p=0.002). ConclusionHyoscine butylbromide oxytocin shortens the duration of labor in term primigravida pregnancies. No side effects were reported." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Placebo \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BBH \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25.37±6.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25.65±6.555 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.848 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Nulliparous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (30.23%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (27.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.499 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Multiparous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 (69.77%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31 (72.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.499 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Uterine fundus (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32.72±1.821 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32.581±1.845 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.726 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Estimated fetal weight (g) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3220.93±255.004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3228.581±217.226 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.881 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Johnson method (g) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3262.588±294.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3250.325±292.241 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.847 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab871740.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of the characteristics of both groups." ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Placebo \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BBH \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">1st. period (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">139.93±92.484 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">151.186±84.657 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.577 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2nd. period (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.581±9.334 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.186±6.351 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.167 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">3rd. period (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.418±3.265 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.581±3.724 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.82 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab871738.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison in labor evolution." ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Placebo \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BBH \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Fetal weight (g) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3248.139±374.837 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3185.581±397.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.454 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Size (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50.720±1.992 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50.767±1.776 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.908 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Silverman \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Apgar 1min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.209±0.666 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.209±0.406 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Apgar 5min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9.186±0.444 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9±0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Capurro (weeks) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">39.146±1.273 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38.986±1.180 \t\t\t\t\t\t\n 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E.M. Treviño-Salinas

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trevinoemilio@yahoo.com.mx

Corresponding author at: Departamento de Ginecología y Obstetricia del Hospital Universitario “Dr. José Eleuterio González” de la UANL. Av. Madero y Gonzalitos, Col. Mitras centro sin número, C.P. 64460 Monterrey Nuevo León, México. Tel.: +52 81 8389 1111; Mobile: +52 81 81622126.

, G.E. Castillo-Martín del Campo, C. Ayuzo-del Valle, A. Guzmán-López, J.A. Soria-López, J.L. Iglesias-Benavides, R. Ambriz-López

Department of Gynecology and Obstetrics of the “Dr. José Eleuterio González” University Hospital of the Autonomous University of Nuevo León, Mexico

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Labor is a sequential physiological event&#46; It integrates changes that will take place in the myometrium&#44; decidua and cervix&#44; which occur over a period of days&#44; or even weeks&#46; Biochemical changes appear before the onset of uterine contractions and cervical dilatation&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> Labor at term&#44; supposes the liberation of inhibitor factors which affect pregnancy and the myometrium&#44; which sets off an active process through uterine stimulators&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a> Different substances intervene during labor&#44; like prostaglandins &#40;PG&#41;&#44; estrogens and oxytocin&#44; among others&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">It was customary to follow the natural evolution of labor without the application of any method to accelerate it &#40;passive handling of labor&#41;&#44; either that or with the use of medications which accelerate it &#40;active handling of labor&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In the beginning of the 20th century&#44; in 1906&#44; the first uterotonic was discovered&#44; oxytocin&#46; It was not until 1911 when its implementation began to accelerate labor&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a> Oxytocin is a cyclic nonapeptide obtained through chemical synthesis&#46; Its synthetic form is identical to that of a hormone stored in the posterior hypophysis&#44; it stimulates the smooth muscle of the uterine strongly toward the end of the pregnancy&#44; during labor and immediately after childbirth&#46; During this phase&#44; oxytocin receptors in the myometrium increase&#46; This is a fast-acting hormone&#44; with a latent period of under a minute after intravenous application and between 2 and 4<span class="elsevierStyleHsp" style=""></span>min after intramuscular injection&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> In the active phase of the first period of labor&#44; oxytocin is commonly used&#44; in patients who require it in order to cause uterine contractions and to regularize its frequency&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In some countries&#44; in addition to the above&#44; other medications have been used to shorten labor&#44; such as drotaverin and hyoscine <span class="elsevierStyleItalic">N</span>-butylbromide &#40;BBH&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> This is part of a group of scopolamine derivates&#44; which are muscarinic antagonists and have antispasmodic effects&#46; It inhibits cholinergic activity in abdominal and pelvis parasympathetic lymph nodes&#44; having an effect on the smooth muscle of the digestive tract&#44; urinary&#44; biliary&#44; female sexual organ and especially over the uterine&#8211;cervical plexus&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> which explains its effect in cervical dilatation&#46; However&#44; this has not yet been clearly stated&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">This medication does not have effects over uterine contractibility&#59; it does not go through the blood&#8211;brain barrier and its fixation to proteins is very low&#44; with a very quick distribution&#59; after intravenous administration the time of action is around 10<span class="elsevierStyleHsp" style=""></span>min&#44; with a peak from 20 to 60<span class="elsevierStyleHsp" style=""></span>min and an average life ranging from 4 to 5<span class="elsevierStyleHsp" style=""></span>h&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> Its main way of excretion is renal&#46; No adverse effects during pregnancy or lactation have been proven&#59; however&#44; its use is recommended with caution under the first trimester&#46; Side effects include&#58; dry mouth&#44; facial flushing&#44; intermittent loss of accommodation reflexes&#44; urinary retention and constipation&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">There have been few studies in which the use of BBH was evaluated to shorten labor&#46; These have reported the reduction of labor time compared to the control group which received placebo&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> and one study compared its effectiveness versus oxytocin&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> The objective of our study was to compare the efficacy and safety of BBH versus placebo during labor&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materials and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">A randomized experimental study was designed in which patients older than 18 years were included&#44; with a term pregnancy &#40;37&#8211;42 weeks&#41;&#44; independent from the parity with cephalic presentation&#44; with a clinically adequate pelvis for labor&#44; where there was no evidence of macrosomia &#40;estimated fetal weight over 4000<span class="elsevierStyleHsp" style=""></span>g&#41; and who were in the first period of labor in the active phase &#40;dilatation of 4<span class="elsevierStyleHsp" style=""></span>cm or more&#41; with regular uterine activity &#40;3&#8211;4 contractions in 10<span class="elsevierStyleHsp" style=""></span>min&#41;&#46; We excluded all patients who needed to complete childbirth abdominally due to different causes&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Patients who were eligible for this study were chosen randomly to receive active treatment with BBH versus a placebo using a sampling of two proportions&#44; in an infinite population&#44; with a potency of 90&#37; to detect the difference of 30&#37; among the study groups&#59; a statistically significant level of 0&#46;05 was established&#46; Over these premises a sample size of 40 patients per group was calculated&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The study included a total of 86 women who met the inclusion criteria and who went to the Emergency Service of the &#8220;Dr&#46; Jos&#233; E&#46; Gonz&#225;lez&#8221; University Hospital for the resolution of their pregnancy between June 2009 and July 2010&#46; All patients signed an informed consent&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The patients were randomly distributed into one of the two groups&#58; the cases group&#44; with 43 patients who were administered 20<span class="elsevierStyleHsp" style=""></span>mg of BBH &#40;diluted in 9<span class="elsevierStyleHsp" style=""></span>ml of saline solution&#41; intravenously on two occasions with an interval of 1<span class="elsevierStyleHsp" style=""></span>h&#44; and the control group with 43 patients who were administered a placebo &#40;10<span class="elsevierStyleHsp" style=""></span>ml of saline solution&#41; at a similar dosage and interval&#46; After every dose&#44; fetal and maternal cardiac frequency monitoring was performed and patients were questioned about side effects&#46; Labor progress was evaluated in a conventional manner&#44; monitoring the time of every period of labor&#44; in addition to the events occurring during its evolution &#40;spontaneous rupture of membranes&#44; analgesia&#44; forceps application&#44; etc&#46;&#41;&#46; Also weight at birth&#44; Apgar and Capurro were evaluated&#46; Maternal and fetal complications were evaluated &#40;uterine atony&#44; vaginal and perineal tears&#44; etc&#46;&#41; after childbirth&#46; Central tendency measurements were utilized and the duration of every period of labor was determined&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The differences between groups were compared with <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> or Fisher&#39;s exact test in the case of categorical variables and with the Student&#39;s <span class="elsevierStyleItalic">t</span>-test for continuous variables&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">A total of 90 patients were included in the study&#46; Of these&#44; we discarded two patients from the case group and two from the control group&#44; because it became necessary for them to have an abdominal birth&#46; The cervical conditions of the placebo group upon entry were&#58; dilation of 5&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;5<span class="elsevierStyleHsp" style=""></span>cm&#44; 73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#37; effacement and Bishop Index of 8&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2&#46; And in the BBH group they were&#58; dilation of 5&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3<span class="elsevierStyleHsp" style=""></span>cm&#44; 72<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#37; effacement and Bishop Index of 8&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2&#46; Upon comparison of these variables&#44; there was no statistically significant difference&#44; which indicates that these two groups were homogenous &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Regarding the results of the duration of labor&#44; the first period of labor&#44; evaluated in minutes&#44; was 139&#46;93<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>92&#46;4 in the placebo group versus 151&#46;186<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>84&#46;6 in the BBH group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>NS&#41;&#46; The second period of labor had a duration of 15&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;33<span class="elsevierStyleHsp" style=""></span>min in the first group and 13&#46;18<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;35<span class="elsevierStyleHsp" style=""></span>min in the second &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>NS&#41;&#46; Finally&#44; the third period registered a time of 6&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;2<span class="elsevierStyleHsp" style=""></span>min in the placebo group and 6&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;7<span class="elsevierStyleHsp" style=""></span>min in the BBH group&#46; We were unable to find a statistically significant difference &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Upon separating the groups by number of pregnancies&#44; we found that the BBH group had a 159&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>84<span class="elsevierStyleHsp" style=""></span>min time for the first phase of labor&#44; with significant difference of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#46;002 compared to the control group &#40;262&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>min&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Concerning the perinatal results&#44; we observed a fetal weight of 3248<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>374<span class="elsevierStyleHsp" style=""></span>g&#44; a length of 50&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;9<span class="elsevierStyleHsp" style=""></span>cm and 39&#46;14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2 Capurro weeks in the placebo group&#44; and a fetal weight of 3185&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>397<span class="elsevierStyleHsp" style=""></span>g&#44; a length of 50&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;7<span class="elsevierStyleHsp" style=""></span>cm and 38&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1 Capurro weeks in the BBH group&#46; We were unable to find a statistically significant difference&#46; Concerning the condition of the babies immediately after birth&#44; we reported an Apgar score at the first minute of 8&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6 and 9&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;4 at 5<span class="elsevierStyleHsp" style=""></span>min in the control group&#44; and 8&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;4 at the first minute and 9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0 at 5<span class="elsevierStyleHsp" style=""></span>min in the BBH group&#46; We were unable to find a statistically significant difference &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Previous studies performed with BBH have reported results which vary from no difference in cervical dilation time to decreases greater than 2<span class="elsevierStyleHsp" style=""></span>h&#46; Aggarwal et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> performed a study in which they found that in addition to a 35&#46;6&#37; diminishment in the perception of pain during labor due to the use of intravenous BBH&#44; the first period of labor was reduced in a significant way&#44; from 8<span class="elsevierStyleHsp" style=""></span>h 16<span class="elsevierStyleHsp" style=""></span>min in the control group&#44; to 3<span class="elsevierStyleHsp" style=""></span>h 46<span class="elsevierStyleHsp" style=""></span>min in the BBH group&#46; Samals et al&#46; concluded that using intravenous BBH&#44; at a dose of 20<span class="elsevierStyleHsp" style=""></span>mg&#44; was able to diminish the effort of labor by up to 32&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Other authors recently compared the use of this pharmaceutic to oxytocin without finding a statistically significant difference in the effort of labor&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> which is the reason the use of this medication should be considered as an option for primigravid patients which&#44; for whatever reason&#44; cannot receive oxytocin&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">We can make a recommendation for the use of this pharmaceutic in patients with the results obtained by separately evaluating groups of primigravid and multigravid patients which received BBH vs&#46; a placebo&#59; with regard to the multiparous&#44; there was no significant difference found between any of the groups&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Just like in other studies&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> our results show no adverse effects on the fetus&#44; which were evaluated by the APGAR at 1 and 5<span class="elsevierStyleHsp" style=""></span>min&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="par0100" class="elsevierStylePara elsevierViewall">Based on the results obtained in our investigation&#44; we can conclude that although we were not able to prove a statistically significant decrease in the effort of labor in both groups&#44; we did demonstrate that when the groups of primigravidas and multigravidas are compared separately&#44; the primigravida BBH group showed a statistically significant difference&#44; with a <span class="elsevierStyleItalic">p</span> of 0&#46;002&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Based on the previous studies&#44; we can make a recommendation for the use of BBH in primigravid patients&#44; also demonstrating that the administration of this product is safe during pregnancy&#44; since there were no adverse effects presented during its administration&#44; or among the babies in all the studied population&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Funding</span><p id="par0115" class="elsevierStylePara elsevierViewall">No financial support was provided&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To compare the effects of intravenous hyoscine butylbromide versus placebo on the duration of labor in term pregnancies&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">86 patients were selected and randomly assigned to receive intravenous hyoscine butylbromide &#40;20<span class="elsevierStyleHsp" style=""></span>mg twice&#41; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43&#41; or an intravenous placebo &#40;saline solution 10<span class="elsevierStyleHsp" style=""></span>cc&#41; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43&#41;&#46; We evaluated maternal adverse effects&#44; effects on neonatal Apgar score&#44; cervical dilatation 1<span class="elsevierStyleHsp" style=""></span>h after drug administration and the interval between the onset of labor and delivery&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">No significant differences were observed in the duration of phases of labor between the two groups&#46; No significant differences were found between the groups in Apgar scores at 1 and 5<span class="elsevierStyleHsp" style=""></span>min&#46; No maternal adverse effects were observed or reported due to the use of hyoscine butylbromide or the placebo&#46; On the first phase of primigravidas it shortens the first labor phase up to 159&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>84<span class="elsevierStyleHsp" style=""></span>min vs&#46; the control group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Hyoscine butylbromide oxytocin shortens the duration of labor in term primigravida pregnancies&#46; No side effects were reported&#46;</p></span>"
        "secciones" => array:4 [
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#46;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;555&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;27&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;499&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Multiparous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 &#40;69&#46;77&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 &#40;72&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;499&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Uterine fundus &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&#46;581<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;845&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3228&#46;581<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>217&#46;226&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;881&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Johnson method &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3262&#46;588<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>294&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3250&#46;325<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>292&#46;241&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;847&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;186<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;351&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">3rd&#46; period &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;418<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;265&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;82&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#46;720<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;992&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#46;767<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;776&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;908&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;209<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;666&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;186<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;444&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Capurro &#40;weeks&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&#46;146<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;273&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#46;986<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;547&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Perinatal results&#46;</p>"
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      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:11 [
            0 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Programmed labor"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Jyoti"
                            1 => "P&#46; Singhal"
                            2 => "D&#46; Choudhary"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Obstet Gynaecol India"
                        "fecha" => "2006"
                        "volumen" => "56"
                        "paginaInicial" => "53"
                        "paginaFinal" => "55"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Cunningham FG&#44; McDonald MD&#46; Williams obstetrics&#46; 20a Edici&#243;n&#46; McGraw Hill&#46; p&#46; 243&#8211;292&#46;"
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Molecular mechanisms regulating the effects of oxytocin on myometrial intercellular calcium"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46;M&#46; Sanborn"
                            1 => "K&#46; Dodge"
                            2 => "M&#46; Monga"
                            3 => "A&#46; Qian"
                            4 => "W&#46; Wang"
                            5 => "C&#46; Yue"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Adv Exp Med Biol"
                        "fecha" => "1998"
                        "volumen" => "449"
                        "paginaInicial" => "227"
                        "paginaFinal" => "286"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Drotaverine hydrochloride for augmentation of labor"
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Article information

ISSN: 16655796
Original language: English

DOI:10.1016/j.rmu.2015.01.001

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Year/Month	Html	Pdf	Total

2024 November	72	1	73
2024 October	501	5	506
2024 September	653	10	663
2024 August	535	6	541
2024 July	692	9	701
2024 June	468	14	482
2024 May	370	11	381
2024 April	399	18	417
2024 March	444	10	454
2024 February	407	11	418
2024 January	450	19	469
2023 December	325	14	339
2023 November	350	20	370
2023 October	379	27	406
2023 September	318	8	326
2023 August	289	10	299
2023 July	310	15	325
2023 June	270	17	287
2023 May	394	34	428
2023 April	406	15	421
2023 March	333	7	340
2023 February	226	16	242
2023 January	176	7	183
2022 December	187	13	200
2022 November	273	12	285
2022 October	261	13	274
2022 September	263	7	270
2022 August	348	12	360
2022 July	221	19	240
2022 June	229	18	247
2022 May	201	18	219
2022 April	217	14	231
2022 March	308	17	325
2022 February	306	10	316
2022 January	346	14	360
2021 December	208	12	220
2021 November	323	17	340
2021 October	401	22	423
2021 September	548	14	562
2021 August	390	11	401
2021 July	346	15	361
2021 June	358	8	366
2021 May	350	18	368
2021 April	1016	44	1060
2021 March	757	15	772
2021 February	353	15	368
2021 January	440	13	453
2020 December	364	19	383
2020 November	359	25	384
2020 October	275	15	290
2020 September	333	19	352
2020 August	306	15	321
2020 July	215	7	222
2020 June	245	7	252
2020 May	313	20	333
2020 April	404	18	422
2020 March	354	15	369
2020 February	324	15	339
2020 January	276	16	292
2019 December	224	21	245
2019 November	254	17	271
2019 October	214	17	231
2019 September	201	9	210
2019 August	128	7	135
2019 July	148	12	160
2019 June	185	12	197
2019 May	303	20	323
2019 April	210	8	218
2019 March	149	11	160
2019 February	91	10	101
2019 January	88	6	94
2018 December	79	6	85
2018 November	97	5	102
2018 October	52	11	63
2018 September	27	8	35
2018 August	30	9	39
2018 July	53	2	55
2018 June	83	3	86
2018 May	116	6	122
2018 April	143	6	149
2018 March	234	4	238
2018 February	88	2	90
2018 January	60	1	61
2017 December	114	3	117
2017 November	265	4	269
2017 October	271	2	273
2017 September	239	12	251
2017 August	233	4	237
2017 July	305	6	311
2017 June	303	6	309
2017 May	358	11	369
2017 April	385	29	414
2017 March	347	70	417
2017 February	634	4	638
2017 January	340	2	342
2016 December	395	9	404
2016 November	411	10	421
2016 October	428	11	439
2016 September	311	10	321
2016 August	304	12	316
2016 July	281	15	296
2016 June	236	15	251
2016 May	185	24	209
2016 April	160	24	184
2016 March	85	25	110
2016 February	59	24	83
2016 January	57	22	79
2015 December	46	24	70
2015 November	36	27	63
2015 October	43	29	72
2015 September	24	8	32
2015 August	2	4	6

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