INCREASING THE NITRIC OXIDE BIOAVAILABILITY AND ADAPTATION OF MATERNAL-PLACENTAL-FETAL HEMODYNAMICS IN THE TREATMENT OF THE PLACENTAL INSUFFICIENCY

Abstract

Purpose: To reveal changes in maternal, placental and fetal circulation after the inhibitor phosphodiesterase-5 (Sildenafil citrate) use in the treatment of placental insufficiency.Materials and Methods: Based on a randomized double-blinded and placebo-controlled trial, 26 pregnant women with documented placental insufficiency and moderate intrauterine growth retardation at 28-36 weeks of gestation were evaluated for the effect of a single dose of Sildenafil citrate on utero-placental circulation determined by Doppler ultrasound study of the umbilical, fetal middle cerebral arteries and aorta. Cerebro-placental (CPR) and cerebro-aortal ratio (CAR) as the markers of fetal well-being were calculated also.Results: There was no significant changes in the maternal circulation after Sildenafil use. Pulsatility index in the middle cerebral artery was increased (p<0,05) and in the umbilical artery and fetal aorta it had a tendency to decreasing. There was established a significant increasing of the CPR and CAR values, both of them had a vector to values of an uncomplicated pregnancy.Summary: We have safely conducted a clinical trial of a drug not routinely used during pregnancy. Sildenafil in the dose 20 mg was well tolerated, with no increase in maternal or fetal morbidity. It was revealed significant improvement in the fetal and placental blood circulation after single dose of Sildenafil use, so it may be a potential drug in the treatment of the placental insufficiency.

Keywords

• fetal doppler
• cerebroplacental ratio
• nitric oxide bioavailability
• placental insufficiency
• fetal well-being