Is Pethidine Safe during Labor? Systematic Review

A total of 17 studies published from January 1st, 2000, to September 2nd, 2016, with a total of 1,688 participants involved were included in the present review. There was no record of conceptus vitality decrease associated with low doses of pethidine being administered to mothers during labor.

Conclusions

Intramuscular (IM) or intravenous (IV) pethidine at low doses, of up to 50 mg, is safe to administer during labor.

Keywords:
pethidine; safety; labor

Author, publishing date	Type of study/country	N	Dose/route of administration	Neonatal outcomes
El-Refaie et al¹⁶16 El-Refaie TA, El-Said MM, Shoukry AA, Khafagy SM, El-Din AS, Badawy MM. Meperidine for uterine dystocia and its effect on duration of labor and neonatal acid-base status: a randomized clinical trial. J Obstet Gynaecol Res 2012;38(02):383-3892012	RCT/Egypt	120	50 mg/IV	Pethidine x placebo. There were no differences in Apgar scores (7.4 × 7.7), respiratory depression, pH, and arterial blood gases of the NBs.
Khooshideh and Shahriari¹⁷17 Khooshideh M, Shahriari A. A comparison of tramadol and pethidine analgesia on the duration of labour: a randomised clinical trial. Aust N Z J Obstet Gynaecol 2009;49(01):59-632009	RCT/Iran	80	50 mg/IM	Pethidine x tramadol. All Apgar scores at 1 and 5 minutes were > 7. There were 3 cases of fetal distress (2 participants had been given pethidine).
Allameh et al¹⁸18 Allameh Z, Tehrani HG, Ghasemi M. Comparing the impact of acupuncture and pethidine on reducing labor pain. Adv Biomed Res 2015;4:462015	RCT/Iran	30	50 mg/IM	Pethidine x acupuncture x placebo. The Apgar scores were 8/9 in the 3 groups. There were no differences in the number of NBs who passed meconium.
Yilmaz et al¹⁹19 Yilmaz B, Kart C, Kelekci S, et al. Meperidine versus valethamate bromide in shortening the duration of active labor. Int J Gynaecol Obstet 2009;107(02):126-1292009	RCT/Turkey	48	50 mg/IV	Pethidine x valethamate x placebo. There were no differences in the number of NBs who passed meconium or the number of Apgar scores at 1 or 5 minutes < 7.
Sekhavat and Behdad²⁰20 Sekhavat L, Behdad S. The effects of meperidine analgesia during labor on fetal heart rate. Int J Biomed Sci 2009;5(01):59-622009	RCT/Iran	75	50–75 mg/IM	Pethidine x placebo. There was a decrease in the variability of the fetal heart rate. There were no significant adverse effects on the NBs.
Ng et al²¹21 Ng TKT, Cheng BCP, Chan WS, Lam KK, Chan MTV. A double-blind randomised comparison of intravenous patient-controlled remifentanil with intramuscular pethidine for labour analgesia. Anaesthesia 2011;66(09):796-8012011	RCT/China	34	50–75 mg/IM	Pethidine x remifentanil. The Apgar scores were 8/9. No complications were reported.
Elbohoty et al²²22 Elbohoty AEH, Abd-Elrazek H, Abd-El-Gawad M, Salama F, El- Shorbagy M, Abd-El-Maeboud KHI. Intravenous infusion of paracetamol versus intravenous pethidine as an intrapartum analgesic in the first stage of labor. Int J Gynaecol Obstet 2012;118(01): 7-102012	RCT/Egypt	50	50 mg/IV	Pethidine x paracetamol. The Apgar scores at 1 minute were lower in the group using pethidine (6 × 7). All Apgar scores at 5 minutes were 9. No adverse effects or admissions to the intensive care unit were reported.
Fleet et al²³23 Fleet J, Belan I, Jones MJ, Ullah S, Cyna AM. A comparison of fentanyl with pethidine for pain relief during childbirth: a randomised controlled trial. BJOG 2015;122(07):983-9922015	RCT/Australia	51	100 mg/IM, every 3 hours	Pethidine x fentanyl. Apgar score at 1 and 5 minutes was 9 for both groups. There was a higher number of NBs admissions to the nursery with pethidine.
Loughnan et al²⁴24 Loughnan BA, Carli F, Romney M, Doré CJ, Gordon H. Randomized controlled comparison of epidural bupivacaine versus pethidine for analgesia in labour. Br J Anaesth 2000;84(06):715-7192000	RCT/England	213	100 mg/IM,every 2 hours	Pethidine x epidural. No differences in the number of Apgar scores < 9 at 5 minutes.
Keskin et al²⁵25 Keskin HL, Keskin EA, Avsar AF, Tabuk M, Caglar GS. Pethidine versus tramadol for pain relief during labor. Int J Gynaecol Obstet 2003;82(01):11-162003	RCT/Turkey	29	100 mg/IM	Pethidine x tramadol. The Apgar scores of both groups were > 7/9. There were no differences in Apgar scores number of the respiratory depression. There were 3 cases of respiratory depression in the NBs of the participants who were given pethidine (10.3%).
Wee et al²⁶26 Wee MYK, Tuckey JP, Thomas PW, Burnard S. A comparison of intramuscular diamorphine and intramuscular pethidine for labour analgesia: a two-centre randomised blinded controlled trial. BJOG 2014;121(04):447-4562014	RCT/England	240	150 mg/IM	Pethidine x diamorphine. The Apgar at 1 minute was < 7 in 15% of the participants who were given pethidine, and there was need for resuscitation in 19% of the participants.
Sosa et al²⁷27 Sosa CG, Balaguer E, Alonso JG, Panizza R, Laborde A, Berrondo C. Meperidine for dystocia during the first stage of labor: A randomized controlled trial. Am J Obstet Gynecol 2004;191(04): 1212-12182004	RCT/Uruguay	205	100 mg/IV	Pethidine x placebo. There was respiratory depression and acidosis in the NBs whose mothers were given pethidine.
Sharma et al²⁸28 Sharma SK, Alexander JM, Messick G, et al. Cesarean delivery: a randomized trial of epidural analgesia versus intravenous meperidine analgesia during labor in nulliparous women. Anesthesiology 2002;96(03):546-5512002	RCT/United States	207	50 mg/IV + 15 mg/IV, every 10 minute, limited to 100 mg every 2 hours	Pethidine x epidural. There were no differences in arterial blood pH between the two groups. In the group that was given pethidine, Apgar scores < 7 at 1 minute were more frequent.
Sosa et al²⁹29 Sosa CG, Buekens P, Hughes JM, et al. Effect of pethidine administered during the first stage of labor on the acid-base status at birth. Eur J Obstet Gynecol Reprod Biol 2006;129(02):135-1392006	RCT/Uruguay	189	100 mg/IV	Pethidine x placebo. There was no association between pethidine and acidosis in the NBs.
Tsui et al³⁰30 Tsui MHY, Ngan Kee WD, Ng FF, Lau TK. A double blinded randomised placebo-controlled study of intramuscular pethidine for pain relief in the first stage of labour. BJOG 2004;111(07): 648-6552004	RCT/China	25	100 mg/IM	Pethidine x placebo. There were no differences in the pH of the umbilical vein. The number of Apgar scores < 7 at 1 and 5 minutes was equal.
Douma et al³¹31 Douma MR, Verwey RA, Kam-Endtz CE, van der Linden PD, Stienstra R. Obstetric analgesia: a comparison of patient-controlled meperidine, remifentanil, and fentanyl in labour. Br J Anaesth 2010;104(02):209-2152010	RCT/Netherlands	53	49,5 mg/IV + 5 mg/IV, every 5 minutes	Pethidine x fentanyl x remifentanil. The Apgar scores with pethidine were 8.6/9.7. Those using pethidine had umbilical cord IV, blood with pH 5/5 minute 7.21 (0.1)-limitary and NACS 36.8 (2.1)-limitary.
Jain et al³²32 Jain S, Arya VK, Gopalan S, Jain V. Analgesic efficacy of intramuscular opioids versus epidural analgesia in labor. Int J Gynaecol Obstet 2003;83(01):19-272003	RCT/India	39	50–75–100 mg/IM	Pethidine x epidural x tramadol. There were no differences in the Apgar scores at 1 and 5 minutes among the three groups. Umbilical cord pH was similar in all groups.

Vital sign	0	1	2
Pulse rate	Absent	Low (below 100)	More than 100
Respiratory effort	Absent	Slow, irregular	Good, crying
Muscle tone	Flaccid	The presence of any bending of the ends	Active movements
Reflex reaction	No reaction	Grimace	Vigorous cry
Color	Blue, pale	Body pink, blue ends	Completely rosy

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[1] Address for correspondence Rogevando Rodrigues Nunes, Obstretrician, MSc, Universidade de Fortaleza, Fortaleza, CE, 60811-905, Brazil (e-mail: rogevando@hotmail.com).