Sildenafil Citrate and Uteroplacental Perfusion in Fetal Growth Restriction

ABSTRACT

Background: Severe early-onset fetal growth restriction can lead to a range of adverse outcomes including fetal or neonatal death, neurodisability, and lifelong risks to the health of the affected child. Sildenafil, a phosphodiesterase type 5 inhibitor, potentiates the actions of nitric oxide, which leads to vasodilatation of the uterine vessels and might improve fetal growth in utero.

Objective: To evaluate effectiveness and safety of Sildenafil citrate for treatment of intrauterine growth restriction (IUGR).

Design: A prospective randomized control study.

Setting: At Ain shams University hospital and KafrAldwwar main Hospital in El-Beheria governorate.

Subjects: Eighty pregnant women with gestational age between 24 and 34 weeks having singleton pregnancy and suffering from IUGR attending an antenatal clinic.

Methods: Eighty pregnant women with FGR and abnormal umbilical artery Doppler between 24and34 weeks were randomly allocated to sildenafil (n= 40) 25mg tid or placebo (n=40) with a plenty of fluids until delivery.

Main outcome measure: Length of pregnancy, neonatal weight and ICU admission.

Results: Sildenafil treatment was associated with a significant increase in length of pregnancy (P> 0.05) and a significant increase in estimated fetal weight by ultrasound (P<0.05), and was associated with a significant decrease in neonatal ICU admission (P=0.218) and neonatal mortality (P=0.290).

Conclusion: Sildenafil citrate can improve utero-placental perfusion and length of pregnancy in pregnancies complicated by IUGR. It appears to have a significantly positive effect on fetal weight. Sildenafil treatment may offer a new opportunity to improve perinatal outcomes, for pregnancies complicated by IUGR. However these observations require further studies on wide scale.

Keywords: Sildenafil Citrate, Uteroplacental Perfusion, Fetal Growth Restriction

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