Fetal growth restriction (FGR) and preeclampsia are the major causes of neonatal morbidity and mortality, which affect up to 8% of all pregnancies. The pathogenesis in FGR is an abnormal trophoblastic invasion leading to compromised uteroplacental circulation. However, in spite of this understanding and identification of high-risk patients, the management options are limited. There are some new studies which have demonstrated the role of sildenafil citrate in improving vasodilatation of small myometrial vessels and therefore improvement in amniotic fluid index, fetal weight, and even uterine and umbilical artery Doppler patterns. We report here the case of a 31-year-old female with infertility and preconceptional thin endometrium responding well to sildenafil citrate, followed by conception. However, she presented with an early-onset FGR at 26 weeks of gestation, and again after treatment with sildenafil citrate, showed improvement in amniotic fluid index and fetal weight, finally resulting in delivery of a full-term healthy baby with uneventful neonatal course.

have been studied extensively, there are no treatment options available. 3 Oligohydramnios is a common finding in growth-restricted foetus and it is an important diagnostic parameter. Decreased amniotic fluid renders the umbilical cord vulnerable to compression, leading to variable decelerations, caesarean delivery, and possibly fetal death. 4 Oligohydramnios can be defined as amniotic fluid volume <5% for gestational age, amniotic fluid index (AFI) <5 cm or maximal deepest pocket <2 cm. 5 ABSTRACT Background: Intrauterine growth restriction (IUGR) is one of the major reasons for neonatal morbidity and mortality. Oligohydramnios is a common finding in IUGR. In majority of these cases diminished utero-placental blood flow is observed. However, in spite of this understanding and identification of high-risk patients, the management options are limited. Sildenafil citrate, a phosphodiesterase type-5 inhibitor improves utero-placental perfusion. Methods: We present a retrospective interventional study involving 50 adult pregnant women diagnosed with early-onset IUGR (n=38) and oligohydramnios (n=12). Vaginal sildenafil citrate 25 mg t.i.d. was started from the day of diagnosis till delivery. Primary efficacy endpoints included changes in Doppler parameters i.e., amniotic fluid index (AFI), uterine artery (UA)-pulsatility index (PI), resistance index (RI) and systolic diastolic ratio (S/D ratio). Secondary endpoints included live birth, birth weight, Apgar score at birth, neonatal survival to hospital discharge and adverse maternal side effects. Results: There was a statistically significant improvement in UA-PI, RI and S/D ratios (p<0.0001) in all cases. In oligohydramnios cases, treatment showed a statistical significant increase in AFI score (2.86±1.33 cm). The mean birth weight on delivery was 2200 gm with good Apgar scores. No major adverse effects were reported by women using sildenafil citrate vaginally. Conclusions: Sildenafil citrate, by increasing utero-placental perfusion, improves uterine artery Doppler patterns, AFI, fetal weight and overall better neonatal survival rates by reducing neonatal morbidity and mortality. Sildenafil citrate may hold a promising treatment strategy for management of IUGR and oligohydramnios.

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Ectopic pregnancy means implantation of the embryo outside the uterine cavity. It may occur in the fallopian tubes, ovaries or the cervix. Primary ovarian ectopic is a very rare condition. In such cases preservation of ovary is extremely important, particularly in patients with infertility. We report a case of primary ovarian ectopic which was managed conservatively in a patient of primary infertility. Preservation of ovary is extremely important, particularly in patients with infertility.

Background: With advancement in IVF technology and vitrification, use of progesterone and its derivatives to block the LH surge is increasing. This was a prospective randomized controlled trial, in a private reproductive medicine clinic to compare the efficacy of preventing LH surges by using progesterone primed ovarian stimulation (PPOS) against gonadotropin-releasing hormone (GnRH) antagonist, in women with good ovarian reserve undergoing in vitro fertilization (IVF).Method/Design: Study participants (n = 220) who met the inclusion criteria were randomized. Both group participants received hMG from day 2. Group 1 (hMG + DYG) received 10mg tablet Dydrogesterone, thrice a day, from day 2 of stimulation. Group 2 (hMG + GAN) received 0.25 mg of Ganirelix acetate, given subcutaneously from fifth day of stimulation till the day of trigger. Main Outcome Measure(s): The primary outcome measured was the incidence of premature LH surges. All embryos were frozen and transferred in the subsequent cycle. Participants were monitored by serial hormonal assays. Main Outcome Measure (s):The primary point of measurement was the incidence of premature LH surges. We also studied the number of oocytes retrieved, number of embryos formed, implantation and clinical pregnancy rate along with the additional cost per cycle as our secondary end parameters. Result (s):All subjects in both groups had well controlled LH levels suggesting good control over prevention of premature leutinisation. There was no significant difference in the number (mean ± SD) of oocytes retrieved [P = 0.0691] and viable embryos or the pregnancy rate (PR) after FET 48% {43.64, median (IQR)} versus 39% {(35.45, median (IQR)} (P = 0.215). The additional cost per cycle was significantly high in the antagonist group (p < 0.001). Conclusion:Our results suggest that Dydrogesterone effectively inhibited spontaneous ovulation, without affecting the number of retrieved oocytes, embryo quality, implantation and pregnancy rates (PR). The cost difference and patient acceptance between both the groups was significant with Dydrogesterone allowing lower costs and easier (oral) administration thus making IVF cycle more patient friendly.