DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20211143

Tocolytic effect of combined sildenafil citrate and nifedepine versus nifedipine alone for management of preterm labour at a tertiary centre

Urmila Karya, Anupam Rani, Anshi Srivastava

Abstract


Background: This study was conducted to evaluate tocolytic effect of sildenafil citrate and nifedipine versus nifedipine alone for management of preterm labour.

Methods: Prospective randomized study on 80 women aged 18-35 years with singleton pregnancy of 28-34 weeks gestation with preterm labour, fulfilling the inclusion criteria were randomly divided in two groups of 40 each. In regimen A women were given sildenafil citrate and nifedipine while in regimen B nifedipine alone for 72 hours as tocolysis.

Results: Higher mean latency in sildenafil and nifedipine combination regimen compared to nifedipine alone regimen (28.23±18.3 versus 12.98±13.35 days, p<0.001). In regimen A, less days of hospital stay (3.23±0.92 versus 3.9±0.38 days, p<0.0001); improve perinatal outcomes in form of fewer deliveries during hospitalization or within 7 days after discharge (p=0.018); reduction in NICU admission (0.68±1.54 versus 3.18±4.61 days, p=0.002); improvement in birth weight (p<0.001) and fewer neonatal complications. Only minor side-effects like facial flushing (42.5% versus 22.5%, p=0.029), headache (40% versus 25%), dyspepsia (15% versus 2.5%, p=0.047), nasal congestion, palpitation, hypotension, constipation, nausea, dizziness were seen.

Conclusions: Our study found combination of sildenafil citrate with nifedipine as superior and successful regimen with future potential as a tocolytic therapy.

 


Keywords


Preterm labour, Tocolytic agents

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References


Arias F, Bhide AG, Arulkumaran S, Damania K, Daftary SN, eds. Arias’ Practical Guide to High-Risk Pregnancy and Delivery: A South Asian Perspective. 4th edn. Elsevier India; 2014:135-140.

Maher MA, Sayyed TM, El‐Khadry SW. Retracted: Nifedipine alone or combined with sildenafil citrate for management of threatened preterm labour: a randomised trial. BJOG. 2019;126(6):729-35.

Van Geijn HP, Lenglet JE, Bolte AC. Nifedipine trials: effectiveness and safety aspects. BJOG. 2005;112:79-83.

Dunn L, Greer R, Flenady V, Kumar S. Sildenafil in pregnancy: a systematic review of maternal tolerance and obstetric and perinatal outcomes. Fet Diagnos Therap. 2017;41(2):81-8.

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(3):255-9.

Jackson G, Benjamin N, Jackson N, Allen MJ. Effects of sildenafil citrate on human hemodynamics. Am J Cardiol. 1999;83(5):13-20.

Abd El-Naser Abd El-Gaber Ali, Khaled M Abdallah, Ahmed Abdelhamid. Sildenafil Citrate versus Nifedipine and Dydrogesreone in Prevention of Preterm Labor with Short Cervix J. Obstetrics Gynecology and Reproductive Sciences.

El-Far M, El-Motwally AE, Abou Hashem I, Bakry N. Biochemical role of intravaginal sildenafil citrate as a novel antiabortive agent in unexplained recurrent spontaneous miscarriage: first clinical study of four case reports from Egypt. Clin Chem Lab Med. 2009;47(11):1433-8.

Khan RN, Hamoud H, Warren A, Wong LF, Arulkumaran S. Relaxant action of sildenafil citrate (Viagra) on human myometrium of pregnancy. Am J Obstet Gynecol. 2004;191(1):315-21.

De Tejada BM, Karolinski A, Ocampo MC, Laterra C, Hösli I, Fernández D, et al. Prevention of preterm delivery with vaginal progesterone in women with preterm labour (4P): randomised double‐blind placebo‐controlled trial. BJOG. 2015;122(1):80-91.

Palacio M, Cobo T, Antolín E, Ramirez M, Cabrera F, Mozo de Rosales F, et al. Vaginal progesterone as maintenance treatment after an episode of preterm labour (PROMISE) study: a multicentre, double‐blind, randomised, placebo‐controlled trial. BJOG. 2016;123(12):1990-9.

Chiossi G, Costantine MM, Betancourt A, Hankins GD, Longo M, Saade GR, et al. Does sildenafil citrate affect myometrial contractile response to nifedipine in vitro? Am J Obstet Gynecol. 2010;203(3):252-e1.

Abdelhamid A. Comparative study of sildenafil citrate versus dydrogesterone in prevention of preterm labour in pregnant women with short cervix. Al-Azhar Assiut Med J. 2015;13(3):1.