Effects of Intramuscular Pethidine on Labor Duration: A prospective cohort study
Article Sidebar
Main Article Content
Abstract
Objectives: This study evaluated the impact of intramuscular pethidine on labor duration as well as associated maternal and neonatal outcomes.
Materials and Methods: A prospective cohort study at Hatyai Hospital recruited 114 women with singleton, cephalic pregnancies at 37–41 weeks and spontaneous labor in the active phase from May to December 2024. A total of 59 patients chose to receive intramuscular pethidine at a dose of 1 mg/kg, while 41 patients chose not to receive it. Obstetric outcomes, labor characteristics, pain assessment by visual analog scale, and maternal and neonatal drug adverse outcomes were recorded. Multivariable linear regression identified factors associated with labor duration, adjusting for confounders including maternal age, body mass index (BMI), and parity.
Results: The median duration of the active phase of the first stage of labor was significantly shorter in the pethidine group (165 min [interquartile range (IQR) 110, 245]) compared to the non-pethidine group (220 min [IQR 140, 330], p = 0.046). After adjusting for maternal age, BMI, and parity, pethidine administration was found to be associated with a significant reduction in active phase duration by 67.45 minutes (adjusted coefficient = -67.45, 95% confidence interval -118.67, -16.23, p = 0.010). None of birth asphyxia was reported, and no significant differences was observed in neonatal intensive care unit admission. Mild maternal side effects included drowsiness and nausea in the pethidine group, but no severe adverse effects were observed in either group.
Conclusion: Intramuscular pethidine administration significantly shortened the active phase of the first stage of labor compared to the non-pethidine group after adjusting for confounding factors, without increasing adverse maternal or neonatal outcomes.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Zahariah S, Rusdiarti. The effect of fetal weight and uterine contractions on the duration of labor. EAS J Nurs Midwifery 2022;4:202-5.
Wadhwa PD, Entringer S, Buss C, Lu MC. The contribution of maternal stress to preterm birth: issues and considerations. Clin Perinatol 2011;38:351-84.
Wang L, Wang H, Jia L, Qing W, Li F, Zhou J. The impact of stage of labor on adverse maternal and neonatal outcomes in multiparous women: a retrospective cohort study. BMC Pregnancy Childbirth 2020;20:596.
Sangtongrungcharoen P, Ngamkham S. Pain management in labor based on the neuromatrix theory. J North Nurses Assoc Thai 2019;25:1-12.
Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, et al. Pain management for women in labour: an overview of systematic reviews. Cochrane Database Syst Rev 2012;3:CD009234.
Sica-Blanco Y, Rozada H, Remedio MR. Effect of meperidine on uterine contractility during pregnancy and prelabor. Am J Obstet Gynecol 1967;97:1096-100.
DeVoe SJ, DeVoe K Jr, Rigsby WC, McDaniels BA. Effect of meperidine on uterine contractility. Am J Obstet Gynecol 1969;105:1004-7.
Berg TG, Rayburn WF. Effects of analgesia on labor. Clin Obstet Gynecol 1992;35:457-63.
Bricker L, Lavender T. Parenteral opioids for labor pain relief: a systematic review. Am J Obstet Gynecol 2002;186:S94-S109.
Nunes RR, Colares PB, Montenegro JP. Is pethidine safe during labor? Systematic review. Rev Bras Ginecol Obstet 2017;39:686-91.
Yilmaz B, Kart C, Kelekci S, Gokturk U, Sut N, Tarlan N, et al. Meperidine versus valethamate bromide in shortening the duration of active labor. Int J Gynaecol Obstet 2009;107:126-9.
Zhang J, Landy HJ, Troendle J, Burkman R, Haberman S, Gregory KD, et al. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstet Gynecol 2010;116:1281–7.
Vahratian A, Zhang J, Troendle JF, Savitz DA. Maternal pre-pregnancy BMI and timing of labor progression. Obstet Gynecol 2004;104:963–970.
Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage of labour. Cochrane Database Syst Rev 2013;10:CD003934.
Segal S, Csavoy AN, Datta S. The tocolytic effect of catecholamines in the gravid rat uterus. Anesth Analg 1998;87:864-9.
Malvasi A, Vimercati A, Ricci I, Picardi N, Cicinelli E, Kosmas I, et al. Dystocic labor and adrenergic and noradrenergic neurotransmitters: a morphological experimental study. Int J Mol Sci 2022;23:11379.
Kim E, Choi H, Lee S, Park J, Jung M. The effect of pethidine analgesia on labor duration and maternal-fetal outcomes. J Obstet Gynaecol Res 2023;49:678-85.
Middleton P, Shepherd E, Flenady V, McBain RD, Crowther CA. Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more). Cochrane Database Syst Rev 2017;1:CD005302.
Kamyabi Z, Naderi T, Ramazani A. A randomized, placebo-controlled trial of the effects of pethidine on labor pain, uterine contractions, and infant Apgar score. Ann Saudi Med 2003;23:318-20.
Guclu M, Yurtçu N, Çelik S, Çalışkan CS, Hatırnaz Ş, Çelik H. Intramuscular meperidine analgesia at the beginning of active phase shortens labor duration without adverse effects on obstetric lacerations and neonatal outcomes. J Exp Clin Med 2021;38:594-8.
Direkvand-Moghadam A, Delpisheh A, Direkvand-Moghadam A, Fathollahi E. The effects of pethidine on the duration of active labor in nulliparous women. J Bas Res Med Sci 2014;1:60-4.
Kadiroğulları P, Yalçın Bahat P, Şahin B, Gönen İ, Seçkin KD. The effect of pethidine analgesia on labor duration and maternal-fetal outcomes. Acta Biomed 2021;92:e2021065.
Şahin O, Genç S, Çetinkaya N, Mihmanlı V, Yıldırım G, Tekirdağ Aİ. Duration of labor with meperidine versus placebo in singleton term pregnancies: a randomized placebo-controlled study. Eur Arch Med Res 2022;38:42-7.
Puttakul W, Wuttikonsammakit P, Chamnan P. Efficacy of intravenous dextrose-containing fluid in reducing labor duration of pregnant women: a randomized controlled trial. Thai J Obstet Gynaecol 2025;32:450-61.
Kamkong J, Pongsamakthai M, Sripipatanakul M, Tangsiriwatthana T. The effect of hyoscine butylbromide for shortening the active phase of the first stage of labor: a randomized, double-blind, placebo-controlled trial. Thai J Obstet Gynaecol 2024;32:245-53.
El-Refaie TA, El-Said MM, Shoukry AA, Khafagy SM, El-Din AS, Badawy MM. Meperidine for uterine dystocia and its effect on duration of labor and neonatal acid-base status: a randomized clinical trial. J Obstet Gynaecol Res 2012;38:383-9.
Mansoori S, Adams S, Cheater FM. Choice of analgesia in labor on neonatal outcomes, delivery, and maternal satisfaction with pain relief. Clin Eff Nurs 2000;4:11-9.
Chantrasiri R, Wanapirak C, Tongsong T. Entonox® versus pethidine in labor pain relief: a randomized controlled trial. Int J Environ Res Public Health 2021;18:12571.
Beaver WT, Feise GA. A comparison of the analgesic effects of meperidine and morphine in patients with postoperative pain. Clin Pharmacol Ther 1978;23: 617–26.
Mobaraki N, Yousefian M, Seifi S, Sakaki M. A randomized controlled trial comparing use of Entonox with pethidine for pain relief in primigravid women during the active phase of labor. Anesth Pain Med 2016;6:e37420.
Sharmin S, Khanam S, Saha SC, Naher FK, Jahan M, Shukla J, Chowdhury AH, Ashafuddoula A. Intramuscular pethidine for pain relief in the first stage of labor. Ibrahim Card Med J 2017;7:99-105.
Anter ME, Saleh SAA, Allam SS, Nofal AM. Efficacy and safety of intravenous paracetamol in management of labor pains in a low-resource setting: a randomized clinical trial. J Matern Fetal Neonatal Med 2021;35:6320-8.
