Background: Labor is the most perilous journey a woman has to undertake. Painless and short labor is desired by every woman and is a constant aim for obstetrician.

Objectives: To study the efficacy and side effects of Drotaverine and Epidosin (Valethamate) in acceleration of labor and to study their effects on the fetal outcome.

Purpose: This study was undertaken to compare effectiveness of Drotaverine and Epidosin in acceleration of labor.

Method: The present study is a prospective comparative study conducted at Raipur Institute of Medical Sciences. Raipur. from October 2014 to September 2016 over a period of 2 years. 150 antenatal women with 38-41 weeks of gestational age were included in study and were divided into three groups randomly. Group V consisted of 50 women who received Valethamate, group D consisted of 50 women who received Drotaverine and Group C also consisted of 50 cases who received normal saline. Various parameters of duration of labor, mode of delivery, maternal and fetal complications and side effects of these drugs were compared in three groups.

Results: The present study showed that both the drugs shorten the duration of first stage of labor when compared to control, but Drotaverine reduces the duration more than Valethamate bromide. Both in primi and multi this difference was statistically significant. There was no significant difference in duration of second and third stages of labor in between the three groups. Mode of delivery, neonatal outcome were almost similar in the three groups. Minor side effects were more common in Valethamate group than in Drotaverine and control group.

Conclusion: Drotaverine is found to be better than Valethamate in shortening the duration of labor with less side effects. Both the drugs have no major side effects and have good fetomaternal outcome. Thus these drugs are safe, potent and effective drug to be used in active phase of labor.

Keywords: Labor, Drotaverine, Valethamate (epidosin)

1. Cunningham FG, Leveno KJ, Bloom SL,SpongCY,DasheJS,HoffmanBL,et al. Williams obstetrics. 24^thUnited States of America:McGraw Hill companies;2014.
2. Nancy KL. The nature of labour pain. Am J ObstetGynecol 2002;186(5):16-24.
3. Mishra S, Anju T, Runoo B. Effect of drotaverine on cervical dilatation- A comparative study withepidosin. J obstelgynecol Ind. 2002;52:76-9.
4. Tan PC, Jacob R, Omar SZ. Membrane sweeping at initiation of formal labor induction: a randomized controlled trial. Obstet and gynecol. 2006;107(3):569–577.
5. Jenkin G, Young I . Mechanisms responsible for parturition; the use of experimental models. AnimReprod Sci. 2004;82:567–581.
6. Sharami SH, Milani F, Zahiri Z, Mansour-GhanaeiF . A randomized trial of prostaglandin E2 gel and extraamniotic saline infusion with high doseoxytocin for cervical ripening. Med SciMonit.2005 ;11(8): 381– 386.
7. Rayburn WF .Preinduction Cervical Ripening: Basis and Methods of Current Practice. Obstetrical & Gynecological Survey.2002;57(10):683–692.
8. Samuel L,ChristieL,Roberts-Gittens B, Fletcher H, Frederick J.The effect of hyoscine butyl bromide on the first stage of labor in term pregnancies .BJOG. 2007;114:1542-46.
9. Martindale W.MARTINDALE-the extra pharmacopeia.31^stLondon:Rittenhouse book distributors;1996
10. O^, Driscoll, Jackson RJA, Gallagher JT. Prevention of prolonged labor. BMJ.1969;2:477-80.
11. Ludmir J, Sehdev H. Anatomy and physiology of the uterine cervix. Clin Obstet Gynecol. 2000; 43(3): 433-439.
12. Danforth ON. The Distribution and Functional Activity of Cervical Musculature. AM.J.0bst.& Gynecol. 1954; 68 : 1261-1271.
13. Rorie OK, Newton H. Histological and Chemical Studies of the Smooth Muscle in Human Cervix. AM.J. Obstet Gynecol. 1967; 99 : 466-69.
14. Cunningham FG, Leveno KJ, Bloom SL,Spong CY, Dashe JS, Hoffman BL, etal. Physiology of Labor.In: Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL,et aleditors. Williams 24^thed.United States of America: McGraw Hill companies;2014.p.408-09
15. Olah KS, Neilson JP. The Functional Response of Cervix in the First Stage of Labour. Br.J. Obst 1992 ; 99 : 1025.
16. Dutta DC.Norma In:HiralalKonar editor. Text book of Obstetrics, 8^thed.NewDelhi:Jaypee; 2015.p.151
17. Olah KS. Changes in cervical electromyographic activity and their correlation with the cervical response to myometrial activity during labour. Br. J. Obst& gynaecol.1994; 57:157-9.
18. KammKE,StullJT.Myosinphosphorylation,force and maximal shortening velocity in neutrally stimulated tracheal smooth muscle.Am J Physiol.1985;249:238-47.
19. Dokhac L,D ^, AlbisA,JanmotC,etal.Myosin light chain phosphorylation in intact rat uterine smooth muscle AMP.Muscle Res.1986;7:259-68.
20. TanseyMG,WordRA,HidakaHA,etal.Phosphorylation of myosin light chain kinase by multifunctional calmodulin –dependent protein kinase 2 in smooth muscle cells.JBiol Chem.1992;267:1868-74.
21. Steer P.The Methods of Pain Relief used.In:ChamberlainG,Wraight A, Steer P editors. Pain and its relief in childbirth. Edinburgh: Churchill Livingstone;1993.pg 49.
22. Lieberman  E, O'Donoghue  C.  Unintended effects of epidural analgesia during labor: A systematic review.  Am J Obstet Gynecol. 2002; 18( 5):31–68.
23. Leighton  BL, Halpern  SH.  The effects of epidural analgesia on labor, maternal, and neonatal outcomes - a systematic review.  Am J Obstet Gynecol. 2002; 186 (5):69–77.
24. Baveja R, Bhattachary SK, Coyaji BT, Engineer AD, Gogoi MP. Prostaglandin E₂gel and Placebo for cervical ripening. J. Obst and Gynic India. 1988; 38:289-92.
25. O'Driscoll K, Stronge JM, Minogue M.Active management of labour. Br Med J. 1973;3(5872):135–37. 
26. Suranyi S .Use of the Sparmolytic Agent for the Assistance of Labour. Med. Univ. 1972 ; 202-11.
27. Ambiye, Alwani,Sinha R. Valethamate Bromide for acceleration of Labor. ObstetGynaecol Ind. 1985; 35:852-53.
28. Puri M, Rathee S, Garg R. Effect of epidosin on cervical dilatation during labour. ObstetGynaecol Ind. 1988; 38: 427-30.
29. Kuruvila S, Jasper P, Peedicayil A, Mathai M.A randomized controlled trial of valethamate bromide in acceleration of labor. Int J ObstetGynaecol.1992; 38: 93-96.  
30. Mukhopardhyay S,Ghosh R, Sarker B. The effect of epidosin forte in cervical dilatation in labor. ObstetGynaecol Ind. 1997; 45-48.
31. Sharma JB, Pundir P, Kumar A, Murthy NS. Drotaverine hydrochloride vs. valethamate bromide in acceleration of labor. Int J Obstet Gynecol. 2001;74:255-60.  
32. Role of drotaverine in cervical dilatation. Obstet Gynaecol today 2001; 4:208-10.
33. Khosla AH, Bala I,Dahiya K, Sangwan K. A Comparative study of the efficacy of valethamate bromide with drotaverine in Normal Labour.ObstetGynaecol Ind. 2003; 53: 568-70.
34. Mishra SL, Toshniwal A, Benerjee R. Effect of drotaverine on cervical dilatation : a comparative study with epidosin. Obstet. Gynacol Ind. 2002 May; 52(3):76-9
35. Singh KC, Jain P, Goel N, Saxena A. Drotaverine hydrochloride for augmentation of labor. Int J Gynaecol Obstet. 2004 Jan;84(1):17-22
36. Ajmera SK, Shah PK,S hinde GA. Comparative study of Drotaverine v/s Valethamate bromide in cervical phase of labor. Bombay Hosp J.2006;4802:305-9.
37. Roy A, Patra KK, Mukhopadhyay S, Guha S.S tudy of Drotaverine on first stage of labor and pregnancy outcome.J Indian Med Assoc .2007;105:450-2.
38. Soni M. Intravenous drotaverine hydrochloride vs. valethamate bromide in acceleration of labour. ObstetGynaecol Today. 2008; 6:239-41.
39. Gupta B, Nellore V, Mittal S. Drotaverine hydrochloride versus hyoscine-N-butylbromide in augmentation of labor. Int. J Obstet Gynaecol. 2008 Mar; 100(3): 244-7 .
40. Tripti N,Jyothi J.To compare and evaluate the efficacy and safety of Drotaverine and Valethamate Bromide.J Obstet Gynecol India .2009;59(4):324-31.
41. Madhu C, Mahavarkar S, Bhave S. A randomised controlled study comparing drotaverine hydrochloride and valethamate bromide in the augmentation of labour. Arch Gynecol Obstet. 2010;282:11-5. 
42. Ashok KB. International Journal on Collaborative Research on Internal Medicine and Public Health. 2011; 3:279.
43. Dahal P,Banerjee B,Uprety DK, Das BP, Thakur A,Agarval A.Comparative study of efficacy of Drotaverine hydrochloride and Valethamate bromide with Control in first stage of Labour. Health Renassance .2013;11(1):38-42.
44. Jayashree S, Ajjammanavar V, Sujatha MS. Comparision of Drotaverine and Valetha-mate Bromide in First stage of Labor.Int J Biol Med Res.2013;4(2):3215-18.
45. Palii SB, Akkupalli VL,Maddi S.The Comparative Study of Drotaverine Hydrochloride and V alethamate Bromide in First Stage of Labor.J South Asian Feder Obst Gynae .2013;5(2):52-8.
46. Aziz M.Efficacy of Drotin and Epidosin in Cervical dilatation during Labour-A Comparative Study.International Journal of Advanced Research.2015;3(6):104-18.
47. To compare the efficacy of Drotaverine hydrochloride and Valethamate bromide in shortening of the first stage of labour.Int J Reprod Contracept Obstet Gynecol.2015 Aug;4(4):1038-43.
48. Selvaraj SM, Natarajan S. Comparison of drotaverine hydrochloride and valethamate bromide on cervical dilatation. J. Evolution Med. Dent. Sci. 2016;5 (52):3491-4.
49. Leroy MI., Legnier G., Merezak. Isolation and Characterisation of Rolipram Sensitive CAMP- Specific Phosphodiesterase (Type intravenous(IV) PDE) in Human Term Myometrium Cell Signal.  1994; 405-412.
50. Pharmacology ,mechanisms of action and clinical significance of a convenient antispasmodic agent: Drotaverine. JAMA India .The physician’s update.2001;4:59-65.
51. Szatmari I. Pharmacokinetics and metabolism of Drotaverine HCL.Chinon R&D pharmacokinetics and metabolism laboratory,report.1996;1-8.
52. Cxeizel AE, Racz J. Evaluation of drug intake during pregnancy in the Hungarian case control surveillance of congenital anpmalies teratology.1990;42:505-12.
53. Vero T, Farago J.Spasmolytic drug administration in the placental stage.Gyogyszereink.1967;17:309-13.
54. Dutta DC. Induction of labor. In: Hiralal Konar editor. Text book of Obstetrics, 8^thNewDelhi:Jaypee; 2015.p.606.
55. Farkas M, Relief of Pain In Child Birth by a new Antispasmodic. Ther, Hung 15. 1967 ; 4-8.
56. Changede PR. Comparison of injection drotaverine and injection valethamate bromide on duration and course of labor. Int J Reprod Contracept Obstet Gynecol .2016;5:1836-42.
57. Kaur D, Kaur R. Comparison of Drotaverine and Epidosin in first stage of labor. J Obstet GynecolIndia .2003;53(5):449-52.
58. Batukan AC, Özgün MT, Türkyılmaz C. The effect of valethamate bromide in acceleration of labor: a double-blind, placebo-controlled trial. J Turk GerGynecol Assoc.2006;7(3):202-5.
59. Malaysarkar.Astudy of Drotaverine on duration of first stage of labour.JIMSA.2001;13(4):256-7.

Dr Neerja Agarwal

Assistant Professor  Department of OBG Raipur Institute of Medical Sciences Raipur

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.