الفهرس 
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Abstract
Labour is generally considered to be a painful experience and analgesia is regularly required. Pain relief during labour is expected to reduce maternal stress and improve maternal and perinatal outcome. There are a number of different forms of pain relief in labour with differing side effects and efficacious labour pain relief is an important aspect of women‘s health.
The most effective pharmacological intervention is through the use of opioids through an epidural catheter. Other effective interventions include combined spinal/epidural analgesia, low dose epidural analgesia, as well as, patient- controlled analgesia. Although these techniques are effective but require an expert anesthesiologist and continuous maternal and electronic fetal monitoring tools which are not available in all obstetric units especially in developing countries.
There are two types of parenteral analgesic agents, opioids and non- opioids. Opioid include pethidine and morphine. Non opioids include paracetamol and non- steroid anti- inflammatory drugs, which have weaker analgesic effects but they have less maternal and fetal side effects.
This study was applied to compare the efficacy and safety of intravenous paracetamol versus intravenous pethidine hydrochloride.
A total number of 96 primiparous women in the interval between March 2017 till December 2017 were recruited in this randomized controlled study. The study included primiparous singleton term pregnant women, with exclusion of malpresentation,high –risk pregnancy and those who had known hypersensitivity to paracetamol or pethidine.
Concealed random allocation was adopted. Women of the first group received intravenous infusion of 1000 mg of paracetamol in the beginning of the active phase of labour. The women of the second group received intravenous 50 mg of pethidine hydrochloride diluted in 10 ml of normal saline at the beginning of the active phase of labour.
The primary outcome was labour pain perception which was assessed by using visual analogue scale (VAS). Labour pain was assessed initially, after 30 minutes, after 1hour, after 2 hours and after 3 hoursof drug administration.
Secondary outcome was maternal outcome (need for more analgesia, dizziness and nausea /vomiting). Neonatal outcome ( CTG findings at 1 hour and 2 hours after administration of drugs,Apgar scores at 1 and 5 minutes, need for neonatal resuscitation and occurrence of respiratory depression).
The mean age of the included women was 24.33±3.32 years (range: 20-34 years). The mean gestational age was 39.21±1.08 years (range: 37-41 weeks).
Women of both groups showed significant reduction of VAS measured 30 minutes, 1 hour and at 2 hours, there was no significant difference between groups. Almost 50% of the first group needed more analgesia, while 35.4% of the second group needed more analgesia.
Only 2.1% of the first group showed reduced beat to beat variability of the fetal heart recorded on CTG, while 41.7% of the second group showed reduced beat to beat variability of the fetal heart recorded on CTG after 1 hour of drug administration. All cases of the first group showed normal CTG patterns while 4.2% of the second group showed reduced beat to beat variability of the fetal heart recorded on CTG after 2 hour of drug administration.
Regarding the course of labour and the mode of delivery there was no significant difference between both groups.
Regarding the maternal safety and outcome the study showed 14 folds in dizziness and 9 folds in nausea/vomiting associated with pethidine than paracetamol group.
Neonatal outcome, pethidine group showed lower Apgar scores at 1 and 5 minute than paracetamol group. There was almost 6 folds and 4 folds higher rates of need for neonatal resuscitation and occurrence of respiratory depression in the second group.