Effect of sildenafil citrate on mid luteal phase uterine artery blood flow in patients with recurrent pregnancy loss due to impaired uterine artery blood flow

Abstract

Background: Recurrent miscarriage is a traumatic event, which may lead to symptoms of depression, anxiety, low self‑esteem, and other psychosocial consequences. One percent of all women trying to conceive will have three miscarriages or more in their lives. If recurrent miscarriage is defined as two or more miscarriages, the proportion of women with recurrent miscarriages increases to 5%. Decreased uterine and sub-endometrial artery blood flow is considered a causative factor in recurrent abortion. Sildenafil citrate rapidly reduces mean arterial pressure while simultaneously increases heart rate and blood flow to the uterus. Furthermore, sildenafil influences angiogenesis, platelet activation, proliferation of regulatory T cells, and production of pro-inflammatory cytokines and autoantibodies. Aim of the Work: To assess the effect of sildenafil citrate compared to placebo on mid luteal phase uterine artery blood flow. Subjects and Methods: A controlled clinical trial on 80 women diagnosed with recurrent miscarriage was held at recurrent pregnancy loss outpatient clinic at Ain shams university maternity hospital, trans-vaginal uterine doppler was done to all patients before treatment and after oral administration of sildenafil in study group or placebo in control group. Conclusion: Sildenafil citrate oral low dose (25mg) administration improves uterine arterial and sub-endometrial blood flow indices such as systolic/diastolic ratio, pulsatility index, and resistance index.