Original Articles

The Effect of Sildenafil on Pregnancy Outcomes in Pregnant Women With Idiopathic Borderline Oligohydramnios: A Randomized Controlled Trial

Abstract

Objective: Borderline oligohydramnios always produces a dilemma of management and counseling among obstetricians. This study was designed to compare the effect of sildenafil plus fluid therapy versus fluid therapy alone on pregnancy outcomes and AFI improvement in pregnant women complicated by idiopathic borderline oligohydramnios.
Materials and methods: This randomized clinical trial was conducted in Arash Women’s Hospital, Tehran, Iran from 2017 to 2020.  Fifty-one pregnant women with idiopathic borderline oligohydramnios were allocated to two groups. Group 1 received fluid therapy and Group 2 received fluid therapy and Sildenafil 25 mg three times daily for six weeks. AFI was measured at the time of randomization, 24 h after treatment and then weekly for six weeks. The changes in AFI, type of delivery, gestational age at delivery, and neonatal outcomes were compared between the two groups.
Results: After the intervention, the change in AFI between two groups was not statistically significant. Maternal and fetal outcomes are compared between two groups and there was no significant difference between them. The median (Inter-quartile range) AFI after intervention, in Sildenafil group compared with hydration group, were in 24 hours (8.5 vs. 8, p=0.27), first (9.5 vs. 9.1, p=0.74), second (9 vs 10, p=0.12) third (10.4 vs. 9.4, p=0.33), fourth (10.8 vs 9.1, p=0.1) and Fifth week (10 vs 9.3, p=0.5) of follow-up respectively, but none of them were statistically significant.
Conclusion: The findings showed that sildenafil plus fluid therapy do not improve the pregnancy outcomes in women with isolated borderline oligohydramnios compared to fluid therapy alone.

 

1. Rosati P, Guariglia L, Cavaliere AF, Ciliberti P, Buongiorno S, Ciardulli A et al. A comparison between amniotic fluid index and the single deepest vertical pocket technique in predicting adverse outcome in prolonged pregnancy. J Perinat Med 2015; 9: 12-5.
2. Rabie N, Magann E, Steelman S, Ounpraseuth S. Oligohydramnios in complicated and uncomplicated pregnancy: a systematic review and meta‐analysis. Ultrasound Obstet Gynecol 2017; 49: 442-9.
3. HalaAbd El-fttah A, AliSabahRamadan HA. The effect of oral versus intravenous fluid therapy on maternal and neonatal outcomes for women with oligohydramnios. Egyptian Nursing Jouurnal 2018; 15: 228.
4. Yadav P, Basnet T, Yadav SP. Maternal and perinatal outcome in borderline oligohydramnios: a hospital-based studY. International Journal of Medical Science And Diagnosis 2021; 5: 19-21.
5. Ghafarnejad M, Tehrani MB, Anaraki FB, Mood NI, Nasehi L. Oral hydration therapy in oligohydramnios.
J Obstet Gynaecol Res 2009; 35: 895-900.
6. Gizzo S, Noventa M, Vitagliano A, Dall’Asta A, D’Antona D, Aldrich CJ, et al. An update on maternal hydration strategies for amniotic fluid improvement in isolated oligohydramnios and normohydramnios: evidence from a systematic review of literature and meta-analysis. PloS one 2015; 10: e0144334.
7. Malhotra B, Deka D. Duration of the increase in amniotic fluid index (AFI) after acute maternal hydration. Arch Gynecol Obstet 2004; 269: 173-5.
8. Wolman I, Groutz A, Gull I, Gordon D, Geva E, Lessing JB, et al. Is amniotic fluid volume influenced by a 24-hour fast? The Journal of reproductive medicine 2000; 45: 685-7.
9. Ross MG, Cedars L, Nijland MJ, Ogundipe A. Treatment of oligohydramnios with maternal 1-deamino-[8-D-arginine] vasopressin–induced plasma hypoosmolality. Am J Obstet Gynecol 1996; 174: 1608-13.
10. Morad AWA, Abdelhamid AA. Nitric oxide donors for treatment of isolated oligohydramnios: A randomized controlled trial. Middle East Fertility Society Journal 2018; 23: 310-4.
11. Fisk NM, Ronderos-Dumit D, Soliani A, Nicolini U, Vaughan J, Rodeck CH. Diagnostic and therapeutic transabdominal amnioinfusion in oligohydramnios. Obstet Gynecol 1991; 78: 270-8.
12. Ülker K, Çiçek M. Effect of maternal hydration on the amniotic fluid volume during maternal rest in the left lateral decubitus position: a randomized prospective study. J Ultrasound Med 2013; 32: 955-61.
13. da Silva Ferreira RD, Negrini R, Bernardo WM, Simoes R, Piato S. The effects of sildenafil in maternal and fetal outcomes in pregnancy: A systematic review and meta-analysis. PloS one. 2019; 14: e0219732.
14. Choudhary R, Desai K, Parekh H, Ganla K. Sildenafil citrate for the management of fetal growth restriction and oligohydramnios. Int J Womens Health 2016; 8: 367-72.
15. Wareing M, Myers JE, O’Hara M, Baker PN. Sildenafil citrate (Viagra) enhances vasodilatation in fetal growth restriction. J Clin Endocrinol Metab. 2005; 90: 2550-5.
16. Boyce EG, Umland EM. Sildenafil citrate: a therapeutic update. Clin Ther 2001; 23: 2-23.
17. Villanueva-Garcia D, Mota-Rojas D, Hernandez-Gonzalez R, Sanchez-Aparicio P, Alonso-Spilsbury M, Trujillo-Ortega ME ,et al. A systematic review of experimental and clinical studies of sildenafil citrate for intrauterine growth restriction and pre-term labour. J Obstet Gynaecol 2007; 27: 255-9.
18. Sharp A, Cornforth C, Jackson R, Harrold J, Turner MA, Kenny LC et al. Maternal sildenafil for severe fetal growth restriction (STRIDER): a multicentre, randomised, placebo-controlled, double-blind trial. Lancet Child Adolesc Health 2018; 2: 93-102.
19. Dastjerdi MV, Hosseini S, Bayani L. Sildenafil citrate and uteroplacental perfusion in fetal growth restriction. J Res Med Sci 2012; 17: 632-6.
20. Underwood MA, Gilbert WM, Sherman MP. Amniotic fluid: not just fetal urine anymore. J Perinatol 2005; 25: 341-8.
21. Kiran S, Ameen A, Akram A, Jamil M. Comparison of effects of oral maternal hydration and intravenous infusions on Amniotic Fluid Index in third trimester isolated Oligohydramnios. The Professional Medical Journal 2019; 26: 2064-9.
22. Kwon JY, Kwon HS, Kim YH, Park YW. Abnormal Doppler velocimetry is related to adverse perinatal outcome for borderline amniotic fluid index during third trimester. J Obstet Gynaecol Res 2006; 32: 545-9.
23. Asgharnia M, Faraji R, Salamat F, Ashrafkhani B, Dalil Heirati SF, Naimian S. Perinatal outcomes of pregnancies with borderline versus normal amniotic fluid index. Iran J Reprod Med 2013; 11: 705-10.
24. Ashwal E, Hiersch L, Melamed N, Aviram A, Wiznitzer A, Yogev Y. The association between isolated oligohydramnios at term and pregnancy outcome. Arch Gynecol Obstet 2014; 290: 875-81.
25. Patel PK, Pitre DS, Gupta H. Pregnancy outcome in isolated oligohydramnios at term.National Journal of Community Medicine 2015; 6: 84-8.
26. Petrozella LN, Dashe JS, McIntire DD, Leveno KJ. Clinical significance of borderline amniotic fluid index and oligohydramnios in preterm pregnancy. Obstet Gynecol 2011; 117: 338-42.
27. Yenigul NN, Asicioglu O. The Effects of Isolated Oligohydramnios in Term Pregnancies on Labor, elivery Mode, and Neonatal Outcomes . Eurasian Journal of Medical Investigation 2019; 3: 59-64.
28. Jamal A, Kazemi M, Marsoosi V, Eslamian L. Adverse perinatal outcomes in borderline amniotic fluid index. Int J Reprod Biomed 2016;14:705-8.
29. Paauw ND, Terstappen F, Ganzevoort W, Joles JA, Gremmels H, Lely AT. Sildenafil during pregnancy: a preclinical meta-analysis on fetal growth and maternal blood pressure. Hypertension 2017; 70: 998-1006.
30. Dunn L, Greer R, Flenady V, Kumar S. Sildenafil in pregnancy: a systematic review of maternal tolerance and obstetric and perinatal outcomes. Fetal Diagn Ther 2017; 41: 81-8.
31. Ferreira RDDS, Negrini R, Bernardo WM, Simões R, Piato S. The effects of sildenafil in maternal and fetal outcomes in pregnancy: A systematic review and meta-analysis. PLoS One. 2019; 14: e0219732.
Files
IssueVol 16, No 2 (June 2022) QRcode
SectionOriginal Articles
DOI https://doi.org/10.18502/jfrh.v16i2.9482
Keywords
Oligohydramnios Pregnancy Outcome Sildenafil

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Vahid Dastjerdi M, Ghahghaei-Nezamabadi A, Tehranian A, Mesgaran M. The Effect of Sildenafil on Pregnancy Outcomes in Pregnant Women With Idiopathic Borderline Oligohydramnios: A Randomized Controlled Trial. J Family Reprod Health. 2022;16(2):124-131.