E-DRUG: Use of hyoscine to promote the first stage of labour

[Moses Chisale <chisalem@server.whoafr.org>]

E-drug: Use of hyoscine to promote the first stage of labour
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Dear E-druggers,

Would you have any solid data or study on the safety of using hyoscine to
promote first stage of labour. The information is required by the national
standing committee on drugs in Botswana. Apparently, a consultant obstetrician
has recommended that this drug be widely used by midwives and doctors as an
adjunct to labour.

Thank you for your assistance.

Moses Chisale
WHO/AFRO Regional adviser on pharmaceuticals
Harare, Zimbabwe

[note from the moderator: the following text is provided by 
REPRORISK on hyoscine (or scopolamine):

Scopolamine is an anticholinergic agent similar in its actions to 
atropine.  Although scopolamine can be found in a variety of nonprescription 
antidiarrheals and sedatives, it is generally sold in OTC products at
subtherapeutic doses.  The Collaborative Perinatal 
Project included 309 births in which the mothers used scopolamine during
 the first trimester and did not associate this drug with an increase
 in birth defects (1).  Use in laboring women was at one time 
popular; however, this use of scopolamine has largely been abandoned.  
When administered during parturition, scopolamine can produce 
outbursts of uncontrollable behavior and hallucinations in the 
mother. Scopolamine readily crosses the placenta (2) and may also 
produce fetal tachycardia, decreased beat-to-beat variability, and 
may interfere with the detection of fetal bradycardia (3-5). 
Postnatal scopolamine toxicity has also been reported (6). 

The passage of scopolamine into breast milk has not been clearly 
documented.  We did not locate any reports on adverse effects in neonates
 exposed to scopolamine in breast milk.  The American Academy
 of Pediatrics classified scopolamine compatible with breastfeeding (7). 

Selected References 

1.  Heinonen OP et al:  Birth Defects and Drugs in Pregnancy, 
Littleton, Publishing Sciences Group, 1977, pp 346-53. 

2.  Moya F, Throndike V:  The effects of drugs used in labor on the 
fetus and newborn.  Clin Pharmacol Ther 4:628-53, 1963. 

3.  Shenker L:  Clinical experience with fetal heart rate monitoring 
of one thousand patients in labor.  Am J Obstet Gynecol 115:1111-6, 1973. 

4.  Boehm FH, Growdon JH:  The effects of scopolamine and ancillary 
analgesics upon the fetal heart rate recording.  Am J Obstet Gynecol 120:1099-1104, 1974. 

5.  Ayromlooi J et al:  The effects of scopolamine and ancillary 
analgesics upon the fetal heart rate recording.  J Reprod Med 25:323-6, 1980. 

6.  Evens RP, Leopold JC:  Scopolamine toxicity in a newborn. 
Pediatrics 66:329-30, 1980. 

7.  Committee on Drugs, American Academy of Pediatrics.  The transfer 
of drugs and other chemicals into human breast milk. Pediatrics 93:137-150, 1994. 


Wilbert Bannenberg, SADAP Coordinator
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Email WilbertBannenberg@compuserve.com or bannew@hltrsa.pwv.gov.za
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