The effect of propranolol on cesarean section rate in prolonged labor: a systematic review and meta-analysis

Propranolol is widely recognized as a nonselective β-adrenergic receptor blocker known to enhance uterine activity in both pregnant and non-pregnant women. Prolonged labor and serious concerns about maternal and neonatal health prompted us to investigate medical issues. The aim of this systematic review and meta-analysis was to assess the effect of propranolol on cesarean deliveries during prolonged labor.

A systematic search was conducted in databases including PubMed, Cochrane CENTRAL, Science Direct, Google Scholar, Embase, and Web of Science from inception to 1 November 2023. We included randomized clinical trials that evaluated maternal and neonatal outcomes in patients receiving intrapartum propranolol during prolonged labor. Unadjusted risk ratios with 95% confidence intervals were calculated using a fixed-effects model. The I² statistic was used to measure and assess heterogeneity. The primary outcome was cesarean delivery rate, and secondary outcomes included Apgar score, cord arterial pH, neonatal birth weight, neonatal intensive care unit admission, postpartum hemorrhage, and composite maternal and neonatal morbidity.

Of the 704 identified articles, six were included in the meta-analyses. There was a significant difference in cesarean deliveries between propranolol and placebo (RR 0.80, 95% confidence interval 0.59-1.09, P = 0.02). In addition, there was no significant difference between study groups in secondary outcomes.

In this meta-analysis, a notable reduction in cesarean rates was observed when propranolol was given to women in prolonged labor. The results of this meta-analysis show that the use of propranolol safely reduces the need for cesarean deliveries due to labor arrest disorders.