Sildenafil citrate and uteroplacental perfusion in fetal growth restriction

Background: to determine whether the phosphodiesterase type 5 inhibitor, sildenafil citrate, affects uteroplacental perfusion. materials and methods: based on a randomized double-blinded and placebo-controlled trial, forty one pregnant women with documented intrauterine growth retardation at 24-37 weeks of gestation were evaluated for the effect of a single dose of sildenafil citrate on uteroplacental circulation as determined by doppler ultrasound study of the umbilical and middle cerebral arteries. statistical analysis included χ^2-test to compare proportions, and independent-samples t-test and paired student’s t-test to compare continuous variables. results: sildenafil group fetuses demonstrated a significant decrease in systolic/diastolic ratios (0.60 [sd 0.40] [95% cl 0.37-0.84], p=0.000), and pulsatility index (0.12 [sd 0.15] [95% cl 0.02-0.22], p=0.019) for the umbilical artery and a significant increase in middle cerebral artery pulsatility index (mca pi) (0.51 [sd 0.60] [95% cl 0.16-0.85], p=0.008). conclusion: doppler velocimetry index values reflect decreased placental bed vascular resistance after sildenafil. sildenafil citrate can improve fetoplacental perfusion in pregnancies complicated by intrauterine growth restriction. it could be a potential therapeutic strategy to improve uteroplacental blood flow in pregnancies with fetal growth restriction (fgr).