This Trial study about The effect of Entonox associated with duration of labor in Active phase and efficacy for relief pain of labor .So investigators start to study up to 14 months

Investigators will enroll participants in 2 groups by randomized . First group will inhale Entonox and the second group not receive any gas . The participants in Entonox group will inhale gas in 4-5 times for each uterine contraction and Nurse will measure blood pressure , O2 saturation ,pain score before use gas . The outcome,investigators study about Apgar score , duration of labor , pain relief in both group,route of delivery and estimated blood loss

Inclusion Criteria:

• Nulliparity
• Age 18 years old or more
• Gestational age 37-40+6 wks
• Singleton
• Cephalic presentation
• Cervical dilatation > 5 cm
• Estimated fetal weight 2,500-4,000 gm

Exclusion Criteria:

• Estimated fetal weight more than 4,000 gm
• High risk pregnancy (Hypertension in pregnancy ,Endocrine disorder , autoimmune disorder , epilsepsy etc)
• SpO2 < 95 %
• Contraindication for Entonox usage ( Severe head injury , asthma , Pulmonary disease,Otitis media )
• Drug allergy : Metoclopramide , Dimenhydrinate , Pethidine ,Entonox

Pregnant women

Entonox