Comparison between transdermal nitroglycerin and sildenafil citrate in intrauterine growth restriction: effects on uterine, umbilical and fetal middle cerebral artery pulsatility indices.
OBJECTIVE
To evaluate the effects of transdermal nitroglycerin (GTN) and sildenafil citrate on Doppler velocity waveforms of the uterine (UtA), umbilical (UA) and fetal middle cerebral (MCA) arteries in pregnancies with intrauterine growth restriction (IUGR).


METHODS
This was a prospective study of 35 singleton pregnancies (gestational age, 24-31 weeks) with IUGR and abnormal UtA and UA Doppler waveforms. We compared maternal arterial blood pressure and Z-scores of the pulsatility index (PI) of UtA, UA and fetal MCA before and after application of a transdermal GTN patch (average dose, 0.4 mg/h), oral sildenafil citrate (50 mg) or placebo. Statistical analysis was performed by ANOVA for paired samples.


RESULTS
There was a significant decrease in UtA-PI after application of GTN (21.0%) and sildenafil citrate (20.4%). A significant reduction in UA-PI was also observed for both GTN (19.1%) and sildenafil citrate (18.2%). There was no difference in UtA- and UA-PI when the GTN and sildenafil groups were compared. No changes in Doppler velocimetry were observed in the placebo group and no significant change in MCA-PI was observed in any group. Maternal arterial blood pressure decreased with administration of both GTN and sildenafil citrate in those with pre-eclampsia.


CONCLUSIONS
The use of transdermal GTN or sildenafil citrate in pregnancies with IUGR is associated with a significant reduction in both UtA and UA Doppler PI, as well as maternal arterial blood pressure. Neither drug affected the MCA-PI. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
Hospital of Federal University of Santa Catarina, Florianópolis, SC, Brazil.
A
A
Trapani
Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.|Department of Radiology, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
L F
LF
Gonçalves
University of Southern Santa Catarina, Medical School, Palhoça, SC, Brazil.
T F
TF
Trapani
Hospital of Federal University of Santa Catarina, Florianópolis, SC, Brazil.
M J
MJ
Franco
Hospital of Federal University of Santa Catarina, Florianópolis, SC, Brazil.
R N
RN
Galluzzo
Postgraduate Program in Medical Sciences, Federal University of Santa Catarina, Florianopolis, SC, Brazil.
M M S
MM
Pires
D000279:Administration, Cutaneous; D000328:Adult; D001783:Blood Flow Velocity / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D020768:Middle Cerebral Artery / Q000187:drug effects / Q000196:embryology / Q000502:physiology; D005996:Nitroglycerin / Q000008:administration & dosage / Q000494:pharmacology*; D010927:Placental Insufficiency / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D011247:Pregnancy; D011446:Prospective Studies; D011673:Pulsatile Flow / Q000187:drug effects; D000068677:Sildenafil Citrate / Q000008:administration & dosage / Q000494:pharmacology*; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000187:drug effects / Q000502:physiology; D055988:Uterine Artery / Q000187:drug effects / Q000502:physiology; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000494:pharmacology*; D055815:Young Adult
D014665:Vasodilator Agents; D000068677:Sildenafil Citrate; D005996:Nitroglycerin
Doppler ultrasonography; fetal growth restriction; nitroglycerin; phosphodiesterase inhibitors; sildenafil citrate