Comparison between transdermal nitroglycerin and sildenafil citrate in intrauterine growth restriction: effects on uterine, umbilical and fetal middle cerebral artery pulsatility indices

Trapani, Alberto; Gonçalves, Luís F.; Trapani, Thamyris Finger; Franco, M.J.; Galluzzo, Roberto Noya; Pires, Maria Marlene de Souza

doi:10.1002/uog.15673

Cited by 47 publications

(55 citation statements)

References 32 publications

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“…The overall rate of headache was 45.8% (49/107) as documented in 6 studies [12,13,23,24,26,29] . This appeared to be the more commonly reported maternal symptom.…”

Section: Headachementioning

confidence: 90%

“…This appeared to be the more commonly reported maternal symptom. In 4 RCTs [12,23,24,29] , rates of headache were comparable between the SC and the control groups.…”

Section: Headachementioning

confidence: 99%

“…Three RCTs [23,24,29] reported significant reductions in maternal blood pressure amongst women with PET. Only one [23] of these RCTs in addition to other studies [13,17,19,20,22,26] , however, reported sufficient data to estimate the overall rate of hypotension (0%, 0/39).…”

Section: Hypotensionmentioning

confidence: 99%

“…Three RCTs [12,24,29] excluded pregnancies with known fetal anomalies and, along with another RCT [23] , did not report on presence or absence of fetal or congenital anomalies at birth. Consequently, these studies did not contribute to the overall rate of congenital anomalies.…”

Section: Congenital Anomaliesmentioning

confidence: 99%

“…Its use in human pregnancy has largely been restricted to a few specific maternal indications, including severe PH [16][17][18][19][20][21][22] or preeclampsia (PET) [23,24] , and as an adjunct to presumed inadequate uteroplacental perfusion [13,25] and severe early-onset fetal growth restriction (FGR) [12,[26][27][28][29] . This in turn has led to a current ongoing multicentre randomised controlled trial (RCT) of SC for the treatment of severe FGR [30] .…”

mentioning

confidence: 99%

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Sildenafil in Pregnancy: A Systematic Review of Maternal Tolerance and Obstetric and Perinatal Outcomes

Dunn

Greer²,

Flenady³

et al. 2016

Fetal Diagn Ther

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Introduction: This systematic review evaluates maternal tolerance and obstetric and perinatal outcomes following sildenafil citrate (SC) use in human pregnancy. Data Sources: Scopus, PubMed, Cochrane Library, Web of Science, Embase, and Google Scholar were searched. Relevant full-text studies including case series and reports in English were included. Publications were excluded if the pregnancy was terminated or if SC was used only at conception. Results: Sixteen studies were included (n = 165). Indications for use and outcomes were variably reported. Maternal outcomes reported were headache (45.8%, 49/107), visual disturbances (17.3%, 14/81), dyspepsia/epigastric pain (15.8%, 15/95), and hypotension (0%, 0/39). There were more caesarean (83.3%, 55/66) than vaginal deliveries (16.7%, 11/66) and postpartum haemorrhage occurred in 3.9% (3/76) of women exposed to SC. Neonatal outcomes including nursery admission (67.3%, 35/52), Apgar scores <7 at 5 min (7.1%, 4/56), and cord arterial pH <7.1 (0%, 0/17) were reported. Stillbirths (4.3%, 3/69) and neonatal deaths (3.9%, 5/129) were comparable to SC-naïve groups. There were no congenital malformations (0%, 0/35). Conclusions: Despite limited data, overall there does not appear to be any severe adverse maternal side effects nor any increase in the rate of stillbirths, neonatal deaths, or congenital anomalies attributed to SC.

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“…The overall rate of headache was 45.8% (49/107) as documented in 6 studies [12,13,23,24,26,29] . This appeared to be the more commonly reported maternal symptom.…”

Section: Headachementioning

confidence: 90%

“…This appeared to be the more commonly reported maternal symptom. In 4 RCTs [12,23,24,29] , rates of headache were comparable between the SC and the control groups.…”

Section: Headachementioning

confidence: 99%

Section: Hypotensionmentioning

confidence: 99%

Section: Congenital Anomaliesmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Sildenafil in Pregnancy: A Systematic Review of Maternal Tolerance and Obstetric and Perinatal Outcomes

Dunn

Greer²,

Flenady³

et al. 2016

Fetal Diagn Ther

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Maternal Sildenafil vs Placebo in Pregnant Women With Severe Early-Onset Fetal Growth Restriction

et al. 2020

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IMPORTANCE Severe early onset fetal growth restriction caused by placental dysfunction leads to high rates of perinatal mortality and neonatal morbidity. The phosphodiesterase 5 inhibitor, sildenafil, inhibits cyclic guanosine monophosphate hydrolysis, thereby activating the effects of nitric oxide, and might improve uteroplacental function and subsequent perinatal outcomes. OBJECTIVE To determine whether sildenafil reduces perinatal mortality or major morbidity. DESIGN, SETTING, AND PARTICIPANTS This placebo-controlled randomized clinical trial was conducted at 10 tertiary referral centers and 1 general hospital in the Netherlands from January 20, 2015, to July 16, 2018. Participants included pregnant women between 20 and 30 weeks of gestation with severe fetal growth restriction, defined as fetal abdominal circumference below the third percentile or estimated fetal weight below the fifth percentile combined with Dopplers measurements outside reference ranges or a maternal hypertensive disorder. The trial was stopped

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Interventions affecting the nitric oxide pathway versus placebo or no therapy for fetal growth restriction in pregnancy

Pels

Ganzevoort

Kenny

et al. 2023

Cochrane Database of Systematic Reviews

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Comparison between transdermal nitroglycerin and sildenafil citrate in intrauterine growth restriction: effects on uterine, umbilical and fetal middle cerebral artery pulsatility indices

Abstract: Objectives

Cited by 47 publications

References 32 publications

Sildenafil in Pregnancy: A Systematic Review of Maternal Tolerance and Obstetric and Perinatal Outcomes

Sildenafil in Pregnancy: A Systematic Review of Maternal Tolerance and Obstetric and Perinatal Outcomes

Maternal Sildenafil vs Placebo in Pregnant Women With Severe Early-Onset Fetal Growth Restriction

Interventions affecting the nitric oxide pathway versus placebo or no therapy for fetal growth restriction in pregnancy

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