In patients with intrauterine growth restriction, Doppler indicators of the uterine, umbilical, and fetal middle cere bral arteries before and after sildenafil citrate and trans dermal nitroglycerin
Abstract
Introduction
Intrauterine growth restriction (IUGR) is a major cause of perinatal morbidity and mortality. Its diagnosis and treatment constitute one of the most important challenges of present day obstetrics. A drug that could improve maternal and fetal hemodynamics in the setting of early intrauterine growth restriction has potential benefit for at least palliation of this ominous condition. In most instances the etiology of IUGR is unknown. The absence of a uniform etiology may help one understand the existence of the large number of treatments suggested for correcting the problem.
Patients and Methods
The objective of this study was to compare the effect of transdermal nitroglycerin and oral Sildenafil citrate on Doppler indices of uterine, umbilical and fetal middle cerebral arteries, and changes in fetal weigh, abdominal circumference and amniotic fluid volume in fifty pregnant women who attended inpatient and outpatient clinics in the department of Obstetrics & Gynecology in Tanta University Hospitals, and suffering from asymmetrical intrauterine growth restriction.
Results
of the study proved a clear significance of the growing role of transdermal nitroglycerin and Sildenafil citrate for augmenting, feto-placental blood flow in the setting of placental vascular insufficiency and IUGR, as a significant reduction in umbilical artery RI, uterine artery RI in the two groups, also abdominal circumference, AFI and estimated fetal weight were significantly increased after 21 days from treatment. That gives a promising treatment for IUGR patients.
References
ACOG Practice bulletin no. 134: fetal growth restriction. Ameri-can College of Obstetricians and Gynecologists. Obstet Gynecol. 2013; 121(5): 1122-1133. doi: 10.1097/01.AOG.0000429658.85846.f9
Pallotto EK, Kilbride HW. Perinatal outcome and later implica-tions of intrauterine growth restriction. Clin Obstet Gynecol. 2006; 49(2): 257-269.
Miller SL, Loose JM, Jenkin G, Wallace EM. The effects of silde-nafil citrate (Viagra) on uterine blood flow and wellbeing in the in-trauterine growth-restricted fetus. Am J Obstet Gynecol. 2009; 200(1): 102.e1-7. doi: 10.1016/j.ajog.2008.08.029
Wareing M, Myers JE, O'Hara M, Baker PN. Sildenafil citrate (Viagra) enhances vasodilatation in fetal growth restriction. J Clin Endocrinol Metab. 2005; 90(5): 2550-2555. doi: 10.1210/jc.2004-
Zoma WD, Baker RS, Friedman A, Clark KE. Sildenafil citrate (Viagra) increases uterine blood flow and potentiates estrogen-in-duced vasodilation. Am J Obstet Gynecol. 2004; 190:1291-7.
Trapani A Jr, Gonçalves LF, Trapani TF, et al. Perinatal and Hemodynamic Evaluation of Sildenafil Citrate for Preeclampsia Treatment: A Randomized Controlled Trial. Obstet Gynecol. 2016; 128(2): 253-259. doi: 10.1097/AOG.0000000000001518.
Diego Gazzolo, Matteo Bruschettini, Romolo Di Iorio, et al. Maternal Nitric Oxide Supplementation Decreases Cord Blood S100B in Intrauterine Growth-retarded Fetuses. Clinical Chemis-try. 2002; 48(4): 647-650.
Lin TH, Su YN, Shih JC, Hsu HC, Lee CN, Resolution of high uterine artery pulsatility index and notching following sildenafil ci-trate treatment in a growth-restricted pregnancy. Ultrasound Obstet Gynecol. 2012; 40(5): 609-610. doi: 10.1002/uog.11142
Von Dadelszen P, Dwinnell S, Magee LA, et al. Sildenafil citrate therapy for severe early-onset intrauterine growth restriction.BJOG. 2011; 118(5): 624-628. doi: 10.1111/j.1471-0528.2010.02879.x
Mohammed EE, Osama Saed Alashkar, Tamer Mamdouh Abdeldayem, Sarah Alhassan Mohammed. The use of low dose EL-Bheirey AM, et al sildenafil citrate in cases of intrauterine growth restriction. Clin Obstet Gynecol Reprod Med. 2017; 3(4): 1-5. doi: 10.15761/ COGRM.1000192
Wareing M, Myers JE, O’Hara M, Baker PN. Sildenafil citrate (Viagra) enhances vasodilatation in fetal growth restriction. J Clin Endocrinol Metab. 2005; 90(5): 2550-2555. doi: 10.1210/jc.2004-
Trapani A Jr, Gonçalves LF, Pires MMS. Transdermal nitro-glycerin in patients with severe pre-eclampsia with placental insuf-ficiency: effect on uterine, umbilical and fetal middle cerebral ar-tery resistance indices. Ultrasound Obstet Gynecol. 2011; 38: 389-394. doi: 10.1002/uog.8983
Samangaya RA, Mires G, Shennan A, Skillern L, Howe D, McLeod A, Baker PN. A randomised, double-blinded, placebo-controlled study of the phosphodiesterase type 5 inhibitor silde-nafil for the treatment of preeclampsia. Hypertens Pregnancy. 2009; 28(4): 369-382. doi: 10.3109/10641950802601278
Davis DG, Brown PM. Re: glyceryl trinitrate (GTN) patches are unsuitable in hypertensive pregnancy. Aust N Z J Obstet Gynae-col. 2001; 41(4): 474.
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