RESUMO
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