Evaluation of Melatonin Effect on Induction of Labor: - Double blinded Randomized Controlled trial

Background and Aim: Induction of labor (IOL) often leads to cesarean deliveries, particularly in nulliparous women, raising maternal risks and emotional distress. Melatonin, known to enhance uterine contractility by in-creasing oxytocin sensitivity and connexin 43 expression, may improve IOL outcomes. This trial evaluated oral melatonin’s effect on reducing cesarean rates and short-ening labor duration in primigravid women.    
Methods: This double-blinded RCT was conducted at Ain Shams University Maternity Hospital (Egypt) from November 2023 to June 2024. Sixty primigravid women (40–41 weeks, Bishop score <6) were randomized 1:1 to receive oral melatonin (10 mg) or placebo with vaginal misoprostol (25 mcg) every 4–6 hours (max 5 doses). La-bor progress followed WHO partogram protocols, with oxytocin augmentation as needed. Primary outcome was vaginal delivery success; secondary outcomes included induction-to-delivery time, labor stages, APGAR scores, and cesarean rates.    
Results: The melatonin group demonstrated statistically significant improvements in labor outcomes compared to the placebo group, with a higher vaginal delivery rate (76.7% vs. 53.3%, p=0.047) and shorter induction-to-de-livery time (10.2±2.1 vs. 13.8±3.4 hours, p<0.001). First-stage labor duration was reduced by nearly 3 hours (p<0.001), though second-stage labor and placental sep-aration times were comparable (p≥0.27). Neonatal out-comes favored melatonin, with higher 1-minute (p=0.008) and 5-minute APGAR scores (p=0.04). Cesarean rates halved in the melatonin group (23.3% vs. 46.7%, p=0.03), while postpartum hemorrhage incidence remained similar (p=0.41). No maternal or neonatal adverse events were reported, confirming melatonin’s safety and efficacy in optimizing labor outcomes.
Conclusion: The current study demonstrates that mela-tonin supplementation may be beneficial in reducing the duration of labor and cesarean section rates without nega-tively affecting neonatal outcomes.