THE USE OF BUSCOPAN DURING THE FIRST STAGE OF LABOUR

Donald P. C Chan, M.B., B.S., F.R.C.S. (Edin.), F.R.C.S. (Glasg.),

M.R.C.O.G., M.M.S.A. (Lond.), D.Obst. R.C.O.G.
From the Department of Obstetric and Gynaecology, University of Hong Kong

Buscopan (hyoscine-N-butylbromide) has a spasmolytic action on smooth-muscle

organs including the uterus (Wick, 1951). It is claimed that it will reduce the duration
of the first stage of labour by overcoming cervical spasm and promoting cervical dilata-
tion. Leuxner and Thomas (1952), Schirmacher (1955, 1956) and Eydam (1958) showed
that Buscopan has a spasmolytic and labour-accelerating action. They also drew atten-
tion to the fact that side effects associated with the use of atropine and scopolamine are
not encountered with the use of Buscopan.

This paper reports an attempt made to determine if Buscopan is equally effective

among Chinese patients who have, on the whole, relatively higher threshold of pain and
require very little, if any, analgesics during labour.

MATERIAL AND METHOD

Alternate primigravidae, who did not present abnormalities such as cephalopelvic
disproportion, antepartum haemorrhage, prolapse of cord, malpresentation and conditions
requiring elective caesarean section or induction of labour, were grouped at random into
groups A and B. Since the presence or absence of the forewater might have an effect
on the duration of labour, artificial rupture of membranes was performed as a routine in
every patient in both groups when the cervix was 4 cm. dilated. The patients in group A
acted as controls and were managed in the usual way; those in group B received an
intramuscular injection of Buscopan (( ml. or 20 mg.) immediately after the membranes
had been ruptured and another similar dose 1 hour later. It can be seen from Table I
that the patients in the two groups are very much alike and are therefore comparable.

Table I. General Features of the Two Groups of Patients.

Range
Average
Maturity
Before 36 weeks
36 weeks or more
Position
Occipito-anterior
Occipito-posterior
Birth Weight — 2,500 gm
— 3,500 gm
— 3,500 gm
— 4,000 gm

Age
Group A

18—33
24.78
4
53
51
6
2
24
24
7

Group B

17 — 37
24.43
2
54
50
6
0
17
34
5

RESULT
Table II shows that incidence of forceps delivery is higher in group B, but the
incidence of lower-segment caesarean section is almost the same in the two groups,
L.S.C.S.

70

THE BULLETIN OF THE HONG KONG CHINESE MEDICAL ASSOCIATION VOL.

15. 1963

being performed 2 times in group A and 3 times in group B. The indications for caesa-
rean section were uterine inertia in 4 cases and foetal distress, as evidenced by a slow-
ing of foetal heart rate and presence of meconium in the liquor, in one patient in group
B.

Table II.

Mode of Delivery.
Spontaneous delivery
Low-forceps delivery
Mid-forceps delivery
Vacuum extraction
Lower segment caesarean section

The average duration of the three stages of labour is shown in Table III. The
average duration of the first stage of labour was exactly the same in the two groups.
However, when cases delivered by caesarean section are excluded, group A shows a
slight-
ly longer average duration of the first stage, but the increase is certainly not significant.
Again, when cases delivered by caesarean section are excluded, the average duration of
the second stage of labour was only slightly longer in group B, whilst the average dura-
tion of the third stage of labour was practically the same in the two groups. There is
therefore no significant difference between the average duration of all the three stages of
labour in the two groups.

There was no foetal loss in group A. There was one stillbirth among the 56
infants in group B. It was a macerated foetus;, the foetal heart sound was not heard on
admission and foetal movement was not felt for two days prior to her admission.

Group A

49
4
-
2
2

Group B

39
10
2
2
3

Table III. Duration of Labour.

Group A

Average duration of first stage

Average duration of first stage
(excluding L.S.C.S. cases)
Average duration of second stage
(excluding L.S.C.S. cases)
Average duration of third stage
(excluding L.S.C.S. cases)

DISCUSSION
The gatients in the two groups are very much alike and therefore comparable.
Whilst the incidence of abdominal delivery is almost the same in the two groups, that of
forceps delivery is definitely increased in group B given two doses of Buscopan. The
average duration of each of the three stages of labour is more or less similar in the two
groups. The study of the present small series of cases therefore fails to confirm the good
results reported by others and suggests that Buscopan has no value whatsoever in the

10 hr. 18 min.

9 hr. 52 min.

30 min. 32 sec.

9 min. 32 sec.

Group B

10 hr. 17 min.

9 hr. 43 min.

37 min.

9 min. 10 sec.

THE USE OF BUSCOPAN DURING THE FIRST STAGE OF LABOUR

management of patients who are in labour. The theoretic; .1 advantage of its reducing the
duration of the first stage of labour by overcoming cervical spasm and promoting cervical
dilatation has not been confirmed by the present clinical t: rial.

It may be of interest to note that the average duration of the first stage of labour
of 113 primigravidae in the two groups is exactly 1 hour 1 longer than that of a series of
, 1963). The most constant
200 primigravidae studied recently in the same hospital
and significant difference in the management of these two series of patients is that arti-
ficial rupture of membranes has been done as a routine in the present series of cases,
Rupture of membranes does not therefore hasten delivery but seems to slow it. However,
the forewater may play a definite but small part in promoting the dilatation of the cervix.

SUMMARY
It is claimed that Buscopan will reduce the duration. of the first stage of labour by
promoting cervical dilatation. An attempt was therefore made to find out if it really
.1 _i
would.

Alternate cases of primigravidae were assigned at •andom to one of two groups,

A and B. The patients in group A were managed in the t sual way whilst those in group
B received two injections of Buscopan. The patients in the two groups were very much
alike and were therefore comparable. The incidence of forceps delivery was higher in
group B. The average duration of each of the three stage of labour is similar in the two
groups. From the study of this small series of cases, one: can conclude that Buscopan
does not reduce the duration of the first stage of labour aid has no value in the manage-
ment of patients who are in labour.
It has also been shown incidentally in the present study that intact forewater

hastens rather than impedes delivery.

Acknowledgment. I wish to thank Professor Daphne W. C. Chun for her advice and
permission to undertake and report the investigation.

REFERENCES
Chan,vD.P.C. (1963): Brit. Med. Jour., I, 100.
Eydanp- E. (1958): Therapie der Gegenwart, 97, 377.
Leuxrier, E., and Thomas, J. (1952): Munch, med. Wschr., 94f 564.
Schinriacher, H. (1955): Arztl. Forsch., lO, 476.
Schirmacher, H. (1956): Med. Wschr., 1C, 11.
Wick, H. (1951): Arch. exp. Path. Pharmak., 213, 485.