Effectiveness of Sildenafil Citrate in the Management of Oligohydramnios and Intrauterine Growth Restriction

Background: Intrauterine growth restriction (IUGR) and oligohydramnios are the major causative factors linked to increased perinatal morbidity and mortality. IUGR refers to a condition where the fetus fails to achieve its genetically predetermined normal growth, often restricted by impaired placental perfusion. A phosphodiesterase-5 (PDE-5) inhibitor, acts as a vasodilator that enhances utero-placental blood circulation, thereby supporting improved fetal growth. Objective: To determine the therapeutic effectiveness of Sildenafil Citrate in the treatment of IUGR pregnancies associated with impaired sufficiency of placenta. Methods: A prospective interventional study was carried out at Obstetrics and Gynaecology department, Sir Ganga Ram Hospital Lahore from December 2022 to December 2023. Women aged 18 to 35 years diagnosed with IUGR, having an estimated fetal weight below the 10th percentile for gestational age and evidence of impaired uteroplacental circulation, were included and divided into two groups: the study group received standard antenatal care plus Sildenafil Citrate 25 mg orally three times daily, while the control group received standard antenatal care alone. All the patients underwent ultrasound for fetal biometry AFI and umbilical artery Doppler for S/D ratio followed by after one week to monitor blood pressure and fetal well-being, and after two weeks for reassessment of fetal biometry. Data was entered and analyzed via SPSS version 26. Results: Mean age of the patients was 27.1±4.3 years, gestational age was 30.9±1.8 weeks and parity was 1.7±1.3. Baseline demographic and obstetric parameters were similar in both study groups (p >0.05). When compared two- week post-intervention, Sildenafil citrate group demonstrated higher means of abdominal circumference (25.9±1.4 vs. 25.1±1.2, p 0.018); fetal weight (1717.4±306.4 vs. 1582.9±266.2, p 0.054); and lower means of systolic/diastolic ratio (3.6±0.4 vs. 3.8±0.3, p 0.034); amniotic fluid index (6.7±1.4 vs. 6.9±1.0, p 0.554) than the counterpart. Conclusion: Sildenafil Citrate observed to be a potentially effective therapeutic option for managing IUGR and Oligohydramnios.