Abstract

Shahinaz H.El-Shorbagy, Abd-el ghaffar Dawood and Abeer Elshabacy

Intrauterine growth restriction (IUGR) is the failure of fetuses to achieve their full growth potential, and is a major cause of perinatal mortality and morbidity. The etiology of IUGR is multifactorial and is thought to include a combination of maternal, environmental, fetal and placental factors with a resultant decrease in fetal growth. Sildenafil citrate and transdermal nitroglycerin affect uteroplacental blood flow and potentiate fetal growth. The objective of this study is to evaluate the effects of sildenafil citrate (SC) and transdermal nitroglycerin (GTN) in management of intrauterine growth restriction. Fifty patients' singleton pregnancies (gestational age, 22–34 weeks) with IUGR in the present study were subjected to; complete history taking; clinical and blood pressure evaluation. Ultrasonographic examination was done every 2 weeks including fetal biometry: Biparietal Diameter "BPD", Head Circumference "HC", Abdominal Circumference "AC", HC/AC ratio, Femur Length "FL", Estimated Fetal Weight "EFW" to monitor fetal growth and assessment of biophysical profile. We compared every week mean arterial blood pressure (MAP) with Doppler ultrasound of the uterine (UtA), umbilical (UA) and fetal middle cerebral (MCA) arteries in pregnancies with IUGR before and after the use of 20 mg sildenafil citrate oral tablets twice daily or after application of a transdermal GTN (Novartis Ireland Limited) 5mg patch/day. Statistical analysis was performed by ANOVA for paired samples. The use of sildenafil citrate or transdermal GTN in pregnancies with IUGR is associated with non significant difference (>0.05) in demographic data, clinical characteristics and baseline values of fetal biometry in the two treated groups of IUGR. There was a significant reduction in PI, RI waveforms of UtA and UA arteries and MAP in pregnancies with IUGR after administration of either SC or GTN therapy. No significant change in MCA Doppler was observed in both groups. IUGR patients treated by either SC or GTN showed significant reduction in both UtA and UA Doppler wave (PI&RI) as well as MAP, with no effect on MCA Doppler wave (PI&RI). Therapy with either Sildenafil citrate or GTN improves uteroplacental (uterine arteries) and fetoplacental (umbilical arteries) circulation and potentiates fetal growth. Sildenafil citrate could normalize the uteroplacental insufficiency with a favorable fetal outcome better than GTN. Sildenafil citrate could be suggested as first line of the treatments for IUGR patients as it is cheaper, has less maternal or fetal complications.