{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T05:00:52Z","timestamp":1790398852721,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The active phase of labor may be prolonged due to excessive cervical smooth muscle spasms, which hinder natural dilation. Drotaverine hydrochloride, a selective phosphodiesterase\u20104 (PDE\u20104) inhibitor with smooth muscle relaxant properties, has gained interest as a labor\u2010augmenting agent. This study evaluates its effects on labor duration, maternal and neonatal safety, and comparative efficacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review and meta\u2010analysis was conducted using PubMed, Embase, and the Cochrane Library. Eligible studies were English\u2010language RCTs comparing drotaverine with placebo in nulliparous women at \u2265\u200928\u2009weeks' gestation with singleton pregnancies. Primary outcomes were labor duration and cervical dilation rate; secondary outcomes included maternal side effects, neonatal Apgar scores, NICU admission, birth weight, delivery mode, and oxytocin use. Data extraction and risk of bias assessment were performed independently by two reviewers. Statistical analysis was conducted via RevMan 5.4.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Four RCTs (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009825; drotaverine: 415, placebo: 410) were included. Drotaverine significantly increased cervical dilation (MD 0.91\u2009cm\/h; 95% CI,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001) and shortened the active first stage of labor (MD 95.68\u2009min; 95% CI, \u2212146.13 to \u221245.22;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0002). It reduced pain at 30\u2009min post\u2010administration, as assessed using the visual analog scale (VAS) (MD 2.22;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007) but showed no significant effect on later stages, maternal or neonatal outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Drotaverine may enhance cervical dilation and reduce active labor duration with short\u2010term pain relief, without adverse maternal or neonatal effects. Larger studies are needed to confirm long\u2010term safety and comparative effectiveness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/birt.70116","type":"journal-article","created":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T04:41:36Z","timestamp":1790397696000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and Safety of Drotaverine Hydrochloride Versus Placebo in Primigravida Women Undergoing Labor: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6712-7421","authenticated-orcid":false,"given":"Syed Moiz","family":"Abbas","sequence":"first","affiliation":[{"name":"Department of Medicine Jinnah Sindh Medical University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4617-2043","authenticated-orcid":false,"given":"Suheera","family":"Afzoon","sequence":"additional","affiliation":[{"name":"Department of Medicine Jinnah Sindh Medical University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0152-6875","authenticated-orcid":false,"given":"Safa","family":"Mazhar","sequence":"additional","affiliation":[{"name":"Department of Medicine Jinnah Sindh Medical University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0826-519X","authenticated-orcid":false,"given":"Hiba","family":"Zafar","sequence":"additional","affiliation":[{"name":"Department of Medicine Jinnah Sindh Medical University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0720-258X","authenticated-orcid":false,"given":"Syeda","family":"Emmama","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7866-099X","authenticated-orcid":false,"given":"Javeria","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4675-2822","authenticated-orcid":false,"given":"Areeba","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Medicine Jinnah Sindh Medical University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6109-0962","authenticated-orcid":false,"given":"Maimoona","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0632-3846","authenticated-orcid":false,"given":"Muhammad","family":"Farhan","sequence":"additional","affiliation":[{"name":"Department of Medicine Jinnah Sindh Medical University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"e_1_2_16_2_1","volume-title":"WHO Recommendations for Augmentation of Labor","author":"World Health Organization","year":"2014"},{"issue":"6","key":"e_1_2_16_3_1","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1097\/AOG.0b013e3181fdef6e","article-title":"Contemporary Patterns of Spontaneous Labor With Normal Neonatal Outcomes","volume":"116","author":"Zhang J.","year":"2019","journal-title":"Obstetrics and Gynecology"},{"key":"e_1_2_16_4_1","article-title":"Antispasmodics for Labor","volume":"3","author":"Hofmeyr G. 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I.","year":"2014","journal-title":"International Journal of Gynaecology and Obstetrics"},{"issue":"6","key":"e_1_2_16_7_1","first-page":"QC05","article-title":"Drotaverine Versus Valethamate Bromide in Acceleration of Labor: A Randomized Controlled Trial","volume":"12","author":"Gupta B.","year":"2018","journal-title":"Journal of Clinical and Diagnostic Research"},{"issue":"3","key":"e_1_2_16_8_1","first-page":"488","article-title":"A Comparative Study of the Effect of Drotaverine Hydrochloride With Hyoscine Butylbromide in First Stage of Labor","volume":"4","author":"Srivastava K.","year":"2017","journal-title":"Int J Basic Clin Pharmacol"},{"key":"e_1_2_16_9_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"372","author":"Page M. 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