Can Sildenafil Citrate Help in the Management of Oligohydramnios?
Sildenafil citrate is a well-known medication used to treat erectile dysfunction and pulmonary arterial hypertension, with positive impact on blood flow. This study by Maher et al. (Obstetrics and Gynecology, 2017) aimed to determine if sildenafil citrate, in combination with hydration, improves the amniotic fluid index (AFI) and neonatal outcomes in pregnancies with idiopathic oligohydramnios.
Randomized Controlled Trial
184 women with singleton pregnancies, ≥ 30 weeks gestation and AFI < 5 cm were either given 25mg of sildenafil citrate every 8 hours and 2L isotonic fluids (treatment) or only the fluids (control) until delivery. Initial treatment was provided in hospital, with IV fluids run at 250 mL/h, and once discharged, patients were asked to take 2 L of fluid orally per day. Primary study outcome was AFI at 6 weeks of follow up or AFI at delivery (depending on what occurred first). 166 of the women completed the follow up (treatment group n=82, control group n=84). AFI at the final assessment was 11.5 cm in the treatment group vs. 5.4 cm in the control group (P=0.02). The sildenafil citrate / hydration group delivered later than those who only received hydration only (38.3 weeks vs. 36 weeks; P=0.001). In addition, C-section rates were lower (28% vs. 73%; P=.001). NICU admissions were likewise reduced (11% vs. 41%; P=0.001). Other statistically significant outcomes that were improved in the treatment arm included umbilical artery pH < 7.2 (P=0.016) and 5-min Apgar scores < 7 (P=0.001). The authors do point out limitations of the study, including lack of placebo, maternal positioning and relationship to AFI was not assessed and AFI, but not actual amniotic fluid volume was analyzed. Nevertheless, the investigators conclude that sildenafil citrate may provide another option to improve pregnancy outcomes complicated by oligohydramios.
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