A Trapani1, L F Gonçalves2,3, T F Trapani4, M J Franco1, R N Galluzzo1, M M S Pires5. 1. Hospital of Federal University of Santa Catarina, Florianópolis, SC, Brazil. 2. Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Rochester, MI, USA. 3. Department of Radiology, Oakland University William Beaumont School of Medicine, Rochester, MI, USA. 4. University of Southern Santa Catarina, Medical School, Palhoça, SC, Brazil. 5. Postgraduate Program in Medical Sciences, Federal University of Santa Catarina, Florianopolis, SC, Brazil.
Abstract
OBJECTIVES: To evaluate the effects of transdermal nitroglycerin (GTN) and sildenafil citrate on Doppler velocity waveforms of the uterine (UtA), umbilical (UA) and fetal middle cerebral (MCA) arteries in pregnancies with intrauterine growth restriction (IUGR). METHODS: This was a prospective study of 35 singleton pregnancies (gestational age, 24-31 weeks) with IUGR and abnormal UtA and UA Doppler waveforms. We compared maternal arterial blood pressure and Z-scores of the pulsatility index (PI) of UtA, UA and fetal MCA before and after application of a transdermal GTN patch (average dose, 0.4 mg/h), oral sildenafil citrate (50 mg) or placebo. Statistical analysis was performed by ANOVA for paired samples. RESULTS: There was a significant decrease in UtA-PI after application of GTN (21.0%) and sildenafil citrate (20.4%). A significant reduction in UA-PI was also observed for both GTN (19.1%) and sildenafil citrate (18.2%). There was no difference in UtA- and UA-PI when the GTN and sildenafil groups were compared. No changes in Doppler velocimetry were observed in the placebo group and no significant change in MCA-PI was observed in any group. Maternal arterial blood pressure decreased with administration of both GTN and sildenafil citrate in those with pre-eclampsia. CONCLUSION: The use of transdermal GTN or sildenafil citrate in pregnancies with IUGR is associated with a significant reduction in both UtA and UA Doppler PI, as well as maternal arterial blood pressure. Neither drug affected the MCA-PI.
RCT Entities:
OBJECTIVES: To evaluate the effects of transdermal nitroglycerin (GTN) and sildenafil citrate on Doppler velocity waveforms of the uterine (UtA), umbilical (UA) and fetal middle cerebral (MCA) arteries in pregnancies with intrauterine growth restriction (IUGR). METHODS: This was a prospective study of 35 singleton pregnancies (gestational age, 24-31 weeks) with IUGR and abnormal UtA and UA Doppler waveforms. We compared maternal arterial blood pressure and Z-scores of the pulsatility index (PI) of UtA, UA and fetal MCA before and after application of a transdermal GTN patch (average dose, 0.4 mg/h), oral sildenafil citrate (50 mg) or placebo. Statistical analysis was performed by ANOVA for paired samples. RESULTS: There was a significant decrease in UtA-PI after application of GTN (21.0%) and sildenafil citrate (20.4%). A significant reduction in UA-PI was also observed for both GTN (19.1%) and sildenafil citrate (18.2%). There was no difference in UtA- and UA-PI when the GTN and sildenafil groups were compared. No changes in Doppler velocimetry were observed in the placebo group and no significant change in MCA-PI was observed in any group. Maternal arterial blood pressure decreased with administration of both GTN and sildenafil citrate in those with pre-eclampsia. CONCLUSION: The use of transdermal GTN or sildenafil citrate in pregnancies with IUGR is associated with a significant reduction in both UtA and UA Doppler PI, as well as maternal arterial blood pressure. Neither drug affected the MCA-PI.
Authors: Anouk Pels; Janus C Jakobsen; Wessel Ganzevoort; Christiana A Naaktgeboren; Wes Onland; Aleid G van Wassenaer-Leemhuis; Christian Gluud Journal: Trials Date: 2019-01-11 Impact factor: 2.279
Authors: Jessica Liauw; Katie Groom; Wessel Ganzevoort; Christian Gluud; Christopher J D McKinlay; Andrew Sharp; Laura Mackay; Chirag Kariya; Ken Lim; Peter von Dadelszen; Jacqueline Limpens; Janus C Jakobsen Journal: Syst Rev Date: 2021-12-03