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

Insulin versus metformin in treatment of gestational diabetes mellitus [randomized controlled clinical trial]

Background: the use of anti-diabetic drugs to control gestational diabetes [GDM] was controversial. Some studies suggested a possible link between the use of oral anti-diabetics and fetal anomalies, fetal macrosomia and neonatal hypoglycemia whereas others have demonstrated no such relationship. Metformin is a biguanide hypoglycemic agent that reduces hepatic gluconeogenesis and increases peripheral insulin sensitivity. Although it crosses placenta, metformin appears to be safe in pregnancy

Aim of the Work: this study aimed to assess the efficacy of metformin in controlling maternal blood glucose level compared to insulin in women with GDM

Patients and Methods: this randomized controlled trial was conducted on 116 patients with GDM recruited from the outpatient clinic of Ain Shams University Maternity Hospital [ASMH], Cairo, Egypt from February, 2016 to January, 2017

Results: macrosomic baby was significantly less frequent among metformin group than among insulin group [p= 0.047]

Conclusion: metformin has efficacy as that of insulin in glycemic control of GDM and has the following beneficial effects: reduction the rate of shoulder dystocia, reduction the rate of cesarean section and reduction the rate of macrosomia more than insulin

Recommendations: metformin is recommended as an alternative to insulin therapy in control of blood glucose in patient with GDM when diet therapy and exercise fail to reduce blood glucose values sufficiently. The time for metformin as an alternative treatment to insulin has come; however, it should be prescribed after careful consideration of these patient characteristics to minimize the need for supplemental insulin