A Randomized Controlled Trial Evaluating the Role of Sildenafil in the Treatment of Fetal Growth Restriction

Abstract

Fetal growth restriction (FGR) is an important cause of perinatal morbidity and mortality. The accurate assessment of fetal growth during pregnancy is difficult, but recent advances have improved this important aspect of obstetric care with positive implications for antenatal patients and their babies. The term ‘small for gestational age‘(SGA): defines an infant that has failed to achieve a weight threshold (usually defined as the 10th percentile). Normal fetal growth is dependent on intrinsic (genetic) and extrinsic (placental and maternal) factors. A failure of any or a combination of these factors will impair growth in affected fetuses. The identification of the specific cause of FGR prior to delivery is essential because clinical management, parental counseling and pregnancy outcome are linked to the etiology. To achieve optimal fetal growth, adequate blood flow in uteroplacental vascular function is essential. Abnormal vasculature adaptation, resulting in aberrant blood flow, has been implicated as a possible cause of (FGR). Sildenafil citrate, a specific phosphodiesterase-5 (PDE-5) inhibitor, has been proposed as a vasodilator and should be an alternative therapeutic agent in FGR gestations by promoting myometrial small artery vasodilatation, reducing in maternity peripheral resistance and increasing flow within the uteroplacental bed and also can improve uteroplacental perfusion. PDE-5 inhibitors can reduce