DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20184988

Sildenafil citrate therapy in absent end diastolic flow in umbilical artery in an early onset fetal growth restriction (FGR) fetus

Rana A. Choudhary, Khyati Patrawala, Kavita Desai, Kedar Ganla

Abstract


Fetal growth restriction (FGR), a pregnancy complication still poses as a challenge for obstetricians worldwide. This is because of its association with severe morbidity and mortality outcomes. Obstetrical management becomes a dilemma in determining the optimal time of delivery and weighing the risks of prematurity against the risks of a potentially hostile intrauterine environment. There may be placental insufficiency characterized by insufficient blood flow in the umbilical artery. This is termed as abnormal umbilical artery flow with absent or reversed end diastolic flow on Doppler USG. Worsening of this condition demands an earlier delivery of the fetus. Authors report a case of structurally normal foetus showing severe early onset FGR with absent end diastolic flow in umbilical artery on Doppler, which was managed using vaginal Sildenafil citrate. Sildenafil citrate led to improvement in uterine artery and umbilical artery Doppler parameters; thereby improving the utero-placental blood flow with a favorable fetal outcome at delivery. The gestation was prolonged by 51 days. Thus, Sildenafil citrate can be used as promising agent in early onset FGR in selected cases.


Keywords


Absent end diastolic flow, Fetal growth restriction, Intra uterine growth restriction, Sildenafil citrate, Umbilical artery

Full Text:

PDF

References


Imdad A, Yakoob MY, Siddiqui S, Bhutta ZA. Screening and triage of intrauterine growth restriction (IUGR) in general population and high-risk pregnancies: a systematic review with a focus on reduction of IUGR related stillbirths. BMC Public Health. 2011;11(3):S1.

Sakamoto M, Osato K, Kubo M, Nii M, Tanaka H, Murabayashi N, et al. Early-onset fetal growth restriction treated with the long-acting phosphodiesterase-5 inhibitor tadalafil: a case report. J Med Case Rep. 2016;10(1):317.

Smith-Bindman R, Chu PW, Ecker JL, Feldstein VA, Filly RA, Bacchetti P. US evaluation of fetal growth: prediction of neonatal outcomes. Radiol. 2002;223(1):153-61.

Connelly D. Three decades of Viagra. Pharma J. 2017. Available at: https://www.pharmaceutical-journal.com/news-and-analysis/infographics/three-decades-of-viagra/20202847.article.

Casanello P, Castro-Rodriguez JA, Uauy R, Krause BJ. Placental epigenetic programming in intrauterine growth restriction (IUGR). Chilean J Pediatr. 2016;87(3):154-61.

Travadi JN, Patole SK. Phosphodiesterase inhibitors for persistent pulmonary hypertension of the newborn: a review. Pediatr Pulmonol. 2003;36:529-55.

Downing JW, Ramasubramanian R, Johnson RF, Minzter BH, Paschall RL, Sundell HW, et al. Hypothesis: selective phosphodiesterase-5 inhibition improves outcome in preeclampsia. Med Hypotheses 2004;63:1057-64.

Sebire NJ, Talbert D. ‘Corplacentale’: placental intervillus/intravillus blood flow mismatch is the pathophysiological mechanism in severe intrauterine growth restriction due to uteroplacental disease. Med Hypotheses. 2001;57:354-7.

Wareing M, Myers JE, O'Hara M, Kenny LC, Taggart MJ, Skillern L, et al. Phosphodiesterase-5 inhibitors and omental and placental small artery function in normal pregnancy and pre-eclampsia. Eur J Obstet Gynecol Reprod Biol. 2006;127(1):41-9.

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):2550-5.

Ballard SA, Gingell CJ, Tang K, Turner LA, Price ME, Naylor AM. Effects of sildenafil on the relaxation of human corpus cavernosum tissue in vitro and on the activities of cyclic nucleotide phosphodiesteraseisozymes. J Urol. 1998;159(6):2164-71.

Choudhary R, Desai K, Parekh H, Ganla K. Sildenafil citrate for the management of fetal growth restriction and oligohydramnios. Int J Womens Health. 2016;8:367-72.

von Dadelszen P, Dwinnell S, Magee LA, Carleton BC, Gruslin A, Lee B, et al. Sildenafil citrate therapy for severe early-onset intrauterine growth restriction. BJOG. 2011;118(5):624-8.