Clinical Experience of Long-Term Transdermal Treatment with Nitric Oxide Donor for Women with Preeclampsia

Abstract

Isosorbide dinitrate (ISDN), a nitric oxide donor, was applied transdermally for 4–16 days to 4 preeclamptic women with oligohydramnios, intrauterine fetal growth retardation (IUGR), and elevated resistance of blood flow in the uterine arteries. Pulsed Doppler ultrasonography revealed immediate and drastic improvement of pulsatility index (PI) of uterine arteries following treatment with ISDN. The average PI in uterine arteries of the 4 patients was reduced to approximately 67% of that of the untreated state. In 2 patients the amniotic fluid gradually increased over a few days which suggested improvement of fetoplacental circulation during administration of ISDN. This study suggests that long-term transdermal ISDN is an effective therapy, at least in a portion of preeclamptic women, to avoid maternal hypertension, fetal distress, oligohydramnios, and IUGR, and consequentially to prolong the gestational period.

Effect of Transdermal Nitroglycerine on Doppler Velocity Waveforms of the Uterine, Umbilical and Fetal Middle Cerebral Arteries in Patients with Chronic Placental Insufficiency: A Prospective RCT

“…But since this is in contradiction to almost all other studies, we can attribute it to the small sample size. In agreement with our results, a study stated that nitric oxide donors reduce the mean maternal blood pressure by affecting both SBP and DBPs; platelet activation and improved haematology, liver biochemistry and liver functions with significant improvement in the uteroplacental and fetoplacental blood flow [12]. Thus nitric oxide donors may be beneficial in the management of preeclampsia as they have a relatively greater vascular than antiplatelet action and reduces blood pressure without affecting uterine artery perfusion.…”

“…Few other studies also observed the similar results for MCA Doppler velocimetry as in our study [6,12]. Nakatsuka M et al, conducted a study in which it was found that no significant changes occored in the PI in the MCA but the ratio of the PI of the umbilical artery over the PI of the MCA, which also indicates fetal hypoxia, was significantly reduced by treatment with transdermal ISDN (p<0.003) [7].…”

“…The utilization of nitroderm patches significantly reduced the umbilical artery S/D ratio and PI [12].…”

Óxido nítrico: propriedades e potenciais usos terapêuticos

“…Recentemente, foram ainda relatados outros usos dos nitratos orgânicos. O DNIS, por ex., foi sugerido na terapia transdérmica de longa duração em mulheres grávidas, para se evitar hipertensão e sofrimento do feto 50 . Foi verificado também que os nitratos orgâ-nicos podem inibir a proliferação celular da musculatura lisa, associada à patogênese e progressão da aterosclerose 51 .…”

Vascular Dysfunction in Women with Recurrent Pregnancy Loss

“…The introduction of pulsed Doppler ultrasonography has provided noninvasive means for the evaluation of uterine impedance, and gives physiologic data, rather than anatomic information alone. It is known that resistance to uterine arterial blood flow is associated with poor obstetrical outcome such as preeclampsia and fetal growth restriction (Nakatsuka et al, 1999b;Nakatsuka et al, 2002;Takata et al, 200).…”