From the Research
Propranolol should not be used for labor dystocia as the most recent and highest quality study found no significant difference in time to vaginal delivery or cesarean delivery rates, but it did reduce composite maternal morbidity. The study published in 2021 in the American Journal of Obstetrics & Gynecology MFM 1 is the most recent and highest quality evidence available, and it found that propranolol did not decrease the time to vaginal delivery or the rate of cesarean delivery. However, it did significantly reduce composite maternal morbidity, including postpartum hemorrhage and transfusion rates, without adverse neonatal effects.
Key Findings
- The 2021 study found no significant difference in time to vaginal delivery or cesarean delivery rates between the propranolol and placebo groups 1.
- Propranolol significantly reduced composite maternal morbidity, including postpartum hemorrhage and transfusion rates, without adverse neonatal effects 1.
- The study had a large sample size and was well-designed, making it the most reliable evidence available.
Clinical Implications
- Propranolol should not be used as a primary treatment for labor dystocia, as it does not improve labor outcomes.
- However, propranolol may be considered as an adjunctive treatment to reduce maternal morbidity, particularly in cases where postpartum hemorrhage is a concern.
- Healthcare providers should prioritize evidence-based interventions, such as oxytocin augmentation, amniotomy, and cesarean delivery, to manage labor dystocia.
Limitations
- The study only included nulliparous women, so the results may not be generalizable to multiparous women.
- The study only used a single dose of propranolol, so the effects of multiple doses or prolonged use are unknown.