Propranolol and Misoprostol Versus Misoprostol Alone for Induction of Labor in Primigravidas

Candidates will be randomized into 2 groups according to a computer generated sequence. Each candidate will be assigned an opaque sealed envelope containing a paper with her group on it. Both the patient and doctor on duty will be blinded to which group the patient was assigned to.

• Study procedure:

• Written informed consent will be obtained from all participants prior to the study.
• Full history taking.
• General examination.

Patients will be subjected to the following:

• Patients attending labour room for induction of labour will be divided into two groups.
• Both groups, women are induced with Tab misoprostol 25μg applied to posterior vaginal fornix under aseptic precaution and every 6 hours for a maximum of 4 doses.
• In group 1, after induction is started with misoprostol placement, 30 minutes will pass before administration of oral Propanolol 20mg
• In group 2, after induction is started with misoprostol placement, 30 minutes will pass before administration of oral placebo in the form of sugary tablets.
• After induction, women will be monitored for fetal and maternal wellbeing and progress of labour.

Inclusion criteria

• • Primigravidas.

• Full term patients with ultrasound confirmed dates.
• Singleton.
• Cephalic presentation.
• Fetal heart rate between 120 to 160 beats per minute.

Exclusion criteria

• • Any history of previous surgery on the uterus.

• Patients in active labour, with ruptured membranes.
• Fetal distress.
• Macrosomia or polyhydramnios
• Hypersensitivity to prostaglandins.
• Asthmatic patient .
• liver or kidney impairment .
• known cardiac patient with abnormal ECG.