Sildenafil citrate and uteroplacental perfusion in fetal growth restriction

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 Kafr Aldwwar 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

Amniotic fluid interleukin - 6 in preterm labor

To evaluate the amniotic fluid levels of interleukin-6 [IL-6] in pregnant women and its potential role in the management of preterm labor. Cross sectional observational study. The Ain Shams University Maternity Hospital during the period from 1st of January 1997 to 30th of June 1997. 80 pregnant women in the third trimester were included in the study. Women included were divided into 4 groups, each consisting of 20 women: [i] group 1: women with term pregnancy not in labor, [ii] group 2: women with term pregnancy in labor, [iii] group 3: women with preterm labor and failed tocolysis, [iv] group 4: women with preterm labor and successful tocolysis. Amniotic fluid samples from these women were obtained and assessed for IL-6 level using an enzyme linked immunoassay. Mean amniotic fluid IL-6 levels were higher in preterm than term pregnancy [259.3 and 205.02 pg/ml respectively]. Mean amniotic IL-6 levels were also higher in women with preterm labor with failed tocolysis than in women with preterm labor with successful tocolysis. The cut off level for IL-6 amniotic fluid level at 159.93 pg/ml showed a sensitivity of 100%, specificity of 85%, positive predictive value of 86.75 and negative predictive value of 100% for the prediction of labor. Amniotic fluid IL-6 level can be a useful marker for labor and may be used as a prognostic factor in the management of preterm labor predicting the response to tocolysis