title: Utero-placental perfusion Doppler indices in growth restricted fetuses: effect of sildenafil citrate.
abstract: OBJECTIVE
  To assess efficacy and tolerability of sildenafil citrate on utero-placental blood flow and fetal growth in pregnancies complicated by fetal growth restriction (FGR).
  
  
  METHODS
  From March 2015, a randomized controlled trial of 54 patients at 24 weeks or more complicated by FGR and abnormal Doppler indices were randomly allocated 1:1 into an intervention arm (receive sildenafil citrate, 50 mg) or a control arm (receive placebo). The primary outcomes were changes occurred in the Doppler parameters 2 h following drug administration.
  
  
  RESULTS
  Baseline characteristics were similar between groups. Significant difference was observed in the Delta uterine and umbilical Doppler indices among sildenafil group as compared to placebo group (p < 0.001). Middle cerebral Doppler indices, however, decreased significantly after sildenafil, which could be the result of shifting more blood to improve the utero-placental perfusion. No difference regarding Delta cerebro-placental ratio among both groups (p = 0.979). Sildenafil was also associated with pregnancy prolongation (p = .0001), increased gestational age at delivery (p = .004), improved neonatal weight (p = .0001), and less admission to neonatal intensive care unit (p = .03). No adverse effects reported in both treatment arms.
  
  
  CONCLUSIONS
  Sildenafil citrate, by its vasodilator effect, can improve utero-placental blood flow in pregnancies complicated by FGR and abnormal Doppler.
  
  
  BACKGROUND
  gov Registry: NCT02362399.
authors.affiliation: a Department of Obstetrics and Gynecology, Faculty of Medicine , Menoufia University , Shebin El Kom , Egypt.
authors.forename: Mohamed Adel
authors.initials: MA
authors.lastname: El-Sayed
authors.affiliation: a Department of Obstetrics and Gynecology, Faculty of Medicine , Menoufia University , Shebin El Kom , Egypt.
authors.forename: Said Abdel-Aty
authors.initials: SA
authors.lastname: Saleh
authors.affiliation: a Department of Obstetrics and Gynecology, Faculty of Medicine , Menoufia University , Shebin El Kom , Egypt.
authors.forename: Mohammad Ahmed
authors.initials: MA
authors.lastname: Maher
authors.affiliation: a Department of Obstetrics and Gynecology, Faculty of Medicine , Menoufia University , Shebin El Kom , Egypt.
authors.forename: Asmaa Mohamed
authors.initials: AM
authors.lastname: Khidre
mesh_terms: D000328:Adult; D004311:Double-Blind Method; D005260:Female; D047109:Fetal Development / Q000187:drug effects*; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D021041:Placental Circulation / Q000187:drug effects*; D011247:Pregnancy; D000068677:Sildenafil Citrate / Q000494:pharmacology / Q000627:therapeutic use*; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014665:Vasodilator Agents / Q000494:pharmacology / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D014665:Vasodilator Agents; D000068677:Sildenafil Citrate
keywords: Fetal growth restriction; middle cerebral artery Doppler; sildenafil citrate; umbilical artery Doppler; uterine artery Doppler