Effectiveness of Sildenafil Citrate in the Management of Oligohydramnios and Intrauterine Growth Restriction
DOI:
https://doi.org/10.21649/akemu.v31i3.5973Keywords:
Sildenafil citrate, Oligohydramnios, IUGRAbstract
Background: Intrauterine growth restriction (IUGR) and oligohydramnios are the major causative factors linked to increased perinatal morbidity and mortality. IUGR refers to a condition where the fetus fails to achieve its genetically predetermined normal growth, often restricted by impaired placental perfusion. A phosphodiesterase-5 (PDE-5) inhibitor, acts as a vasodilator that enhances utero-placental blood circulation, thereby supporting improved fetal growth.
Objective: To determine the therapeutic effectiveness of Sildenafil Citrate in the treatment of IUGR pregnancies associated with impaired sufficiency of placenta.
Methods: A prospective interventional study was carried out at Obstetrics and Gynaecology department, Sir Ganga Ram Hospital Lahore from December 2022 to December 2023. Women aged 18 to 35 years diagnosed with IUGR, having an estimated fetal weight below the 10th percentile for gestational age and evidence of impaired uteroplacental circulation, were included and divided into two groups: the study group received standard antenatal care plus Sildenafil Citrate 25 mg orally three times daily, while the control group received standard antenatal care alone. All the patients underwent ultrasound for fetal biometry AFI and umbilical artery Doppler for S/D ratio followed by after one week to monitor blood pressure and fetal well-being, and after two weeks for reassessment of fetal biometry. Data was entered and analyzed via SPSS version 26.
Results: Mean age of the patients was 27.1±4.3 years, gestational age was 30.9±1.8 weeks and parity was 1.7±1.3. Baseline demographic and obstetric parameters were similar in both study groups (p >0.05). When compared two- week post-intervention, Sildenafil citrate group demonstrated higher means of abdominal circumference (25.9±1.4 vs. 25.1±1.2, p 0.018); fetal weight (1717.4±306.4 vs. 1582.9±266.2, p 0.054); and lower means of systolic/diastolic ratio
(3.6±0.4 vs. 3.8±0.3, p 0.034); amniotic fluid index (6.7±1.4 vs. 6.9±1.0, p 0.554) than the counterpart.
Conclusion: Sildenafil Citrate observed to be a potentially effective therapeutic option for managing IUGR and Oligohydramnios.
References
1. Nasri K, Ghaedi F, Safi F, Latifi SA, Almasi-Hashiani A. Effect of pomegranate juice and sildenafil on intraute- rine growth retardation: a randomized controlled trial. Int J Fertil Steril. 2025;19(2):236. doi: 10.22074/ ijfs. 2024.2015922.1574
2. Elsheikh M, El Amrousy D, El-Mahdy H, Dawoud H, Harkan A, El-Barky A. Lipid profile after omega-3 supplementation in neonates with intrauterine growth retardation: a randomized controlled trial. Pediatr Res. 2023;94(4):1503–1509. doi.org/10.1038/ s41390- 023-02632-z
3. Schlembach D. Fetal growth restriction–diagnostic work-up, management and delivery. Geburtshilfe Frauenheilkd. 2020;80(10): 1016–1025. Doi: 10. 1055/ a-1232-1418
4. D'Agostin M, Morgia CD, Vento G, Nobile S. Long- term implications of fetal growth restriction. World J Clin Cases. 2023;11(13):2855. doi: 10.12998/ wjcc. v11.i13.2855.
5. Beaumann M, Delhaes F, Menétrey S, Joye S, Vial Y, Baud D, et al. Intrauterine growth restriction is associa- ted with sex-specific alterations in the nitric oxide/ cyclic GMP relaxing pathway in the human umbilical vein. Placenta. 2020; 93:83 – 93. doi.org/10.1016/j. placenta.2020.02.014.
6. Faquini SD, Guerra GV, Galindo MW, Gusmão IM, Vilela LS, Souza AS. Prognostic factors and perinatal outcomes in early-onset intrauterine growth restriction due to placental insufficiency. J Matern Fetal Neonatal Med. 2022;12;35(25):7119-25. doi.org/10.1080/ 147
67058.2021.1944092
7. Lloyd-Davies C, Collins SL, Burton GJ. Understanding the uterine artery Doppler waveform and its relationship to spiral artery remodelling. Placenta. 2021;105:78-84. doi.org/10.1016/j.placenta.2021.01.004
8. Zhang P, Baergen R. Atherosis of trophoblast type: a specific form of decidual vasculopathy distinct from atherosis of macrophage type. Arch Pathol Lab Med. 2022;146(10):1224-33. doi. org/10.5858/arpa.2021- 0356-OA.
9. Nemr M, Abdelaziz MA, Teleb M, Elmasry AE, Elshaier YA. An overview on pharmaceutical applications of phosphodiesterase enzyme 5 (PDE5) inhibitors. Mol Divers. 2024;27:1-21. doi.org/10.1007/s11030-024-
11016-2
10. Dastjerdi MV, Hosseini S, Bayani L. Sildenafil citrate and uteroplacental perfusion in fetal growth restriction. J Res Med Sci. 2012;17:632–6. Doi: pmc.ncbi.nlm. nih.gov/articles/PMC3685778/
11. Mostafa T, Alghobary M, Hanafy NS, Abosief A. Oral phosphodiesterase type 5 inhibitors and male reproduc- tive potential: An overview. Sex Med Rev. 2023;11(3):240-52. doi.org/10.1093/sxmrev/qead010
12. Verma S, Singh AL. Role of sildenafil citrate in impro- ving amniotic fluid indices in pregnant women with oligohydramnios: a comprehensive review. Multidiscip Rev. 2024;7(12):2024294. Doi: 10.31893/multirev. 2024294.
13. Hitzerd E, Broekhuizen M, Colafella KM, Glisic M, de Vries R, Koch BC, et al. Placental effects and transfer of sildenafil in healthy and preeclamptic conditions. EBioMedicine. 2019;45:447–455. doi.org/10.1016/ j.ebiom.2019.06.007
14. Paauw ND, Terstappen F, Ganzevoort W, Joles JA, Gremmels H, Lely AT. Sildenafil during pregnancy: a preclinical meta-analysis on fetal growth and maternal blood pressure. Hypertension. 2017;70(5):998-1006. doi.org/10.1161/hypertensionaha.117.09690
15. Sutherland MR, Black MJ. The impact of intrauterine growth restriction and prematurity on nephron endow- ment. Nat Rev Nephrol. 2023;9(4):218-28. doi.org/ 10.1038/s41581-022-00668-8
16. Kamphof HD, Posthuma S, Gordijn SJ, Ganzevoort W. Fetal growth restriction: mechanisms, epidemiology, and management. MFM. 2022; 25;4(03):186-96. DOI: 10.1097/FM9.0000000000000161
17. Muglia LJ, Benhalima K, Tong S, Ozanne S. Maternal factors during pregnancy influencing maternal, fetal, and childhood outcomes. BMC medicine. 2022; 1; 20 (1):418. doi.org/10.1186/s12916-022-02632-6
18. Rakhanova Y, Almawi WY, Aimagambetova G, Riethmacher D. The effects of sildenafil citrate on intrauterine growth restriction: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2023;2; 23(1):409. doi.org/10.1186/s12884-023-05747-7
19. Shehata NAA, Ali HAA, Fahim AS, Katta MA, Hussein GK. Addition of sildenafil citrate for treatment of severe intrauterine growth restriction: a double blind rando- mized placebo controlled trial. J Matern Fetal Neonatal Med. 2018;33(10):1631–7. doi.org/10.1080/147
67058.2018.1523892
20. Trapani Jr A, Goncalves LF, Trapani TF, Franco MJ, Galluzzo RN, Pires MMS. Comparison between trans- dermal nitroglycerin and sildenafil citrate in intrauterine growth restriction: effects on uterine, umbilical and fetal middle cerebral artery pulsatility indices. Ultra- sound Obstet Gynecol. 2016; 48: 61–5. doi.org/ 10. 1002/uog.15673.
21. Maged M, Wageh A, Shams M, Elmetwally A. Use of sildenafil citrate in cases of intrauterine growth restric- tion (IUGR); a prospective trial. Taiwan J Obstet Gynecol . 2018; 57(4) :483–6 .doi.org/10.1016/j.tjog. 2018. 06.002
22. Nasrolahi S, Talebi-Ghane E, Torkashvand L. The effect of sildenafil citrate on improving amniotic fluid index in pregnant women with oligohydramnios and borderline oligohydramnios: a randomized controlled trial. J Ker- manshah Univ Med Sci. 2023;27(2):e135045. doi. org/ 10.5812/jkums-135045
23. Nath J, Chaube S, Rani N, Verma P. Astudy on sildenafil citrate in the treatment of IUGR & Oligohydramnios. Invest Gynecol Res Women’s Health. 2021;4(2):431-5. doi: 10.31031/IGRWH.2021.04.000581
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Annals of King Edward Medical University
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments publications@kemu.edu.pk