Sildenafil citrate for the management of asymmetrical intrauterine growth restriction and its effect on umbilical artery Doppler

Background: Asymmetrical intrauterine growth restriction IUGR occurs when there is uteroplacental insufficiency. Sildenafil citrate phosphodiasterase-5 inhibito is a potent vasodilator, which selectively inhibits phosphodiesterase-5 and, as a consequence, enhances the action of cyclic guanosine monophosphate which is the second messenger of NO. Hence, the trial was used for improving uteroplacental perfusion through enhancing vasodilatation of myometrial small arteries boosting flow within uteroplacental bed. The aim was to evaluate the efficacy of adding sildenafil citrate to low dose aspirin in treatment of asymmetrical IUGR through its effect on uteroplacental blood flow guided by Doppler ultrasound.Methods: Our study was a prospective double-blinded, randomized, controlled trial. Recruitment of participating women was from the obstetric outpatient clinic of Aswan university hospital. 100 patients included in the study and randomized in two groups. The first group was 50 patients assigned sildenafil with low dose aspirin and the second group was 50 patients assigned placebo with low dose aspirin.Results: As regard the outcomes, the study demonstrated that using of SC and LDA were effective in increasing estimated fetal weight and in improvement of umbilical artery umbilical artery Doppler (UAD) indices RI and PI for pregnancy complicated with IUGR compared with the control group.Conclusions: Sildenafil citrate is a promising treatment for IUGR fetuses with prolongation of pregnancy and improvement of fetal birth weight, umblical Doppler indices UDI, decreases days needed in PCU