A Long‐term Transdermal Nitric Oxide Donor Improves Uteroplacental Circulation in Women With Preeclampsia

Abstract

Objective. To determine the effects of long-term transdermal administration (range, 4-30 days; mean ± SD, 11.1 ± 7.2 days) of isosorbide dinitrate, a nitric oxide donor, in preeclamptic women. Methods. We studied uterine and fetoplacental circulation of 12 preeclamptic women with oligohydramnios and an elevated pulsatility index in the uterine arteries. Results. Transdermal isosorbide dinitrate significantly suppressed the blood pressure of patients. Pulsed Doppler ultrasonography revealed that the average pulsatility index in the uterine arteries was significantly reduced by treatment with isosorbide dinitrate (P < .003). The average pulsatility index in the umbilical artery was also significantly reduced (P < .004). Furthermore, the size of the amniotic fluid pocket increased approximately 4-fold by treatment with isosorbide dinitrate. Conclusions. Long-term transdermal administration of isosorbide dinitrate improves fetoplacental circulation and may be effective therapy for avoiding maternal hypertension and oligohydramnios in some preeclamptic women.

Effect of Transdermal Nitroglycerine on Doppler Velocity Waveforms of the Uterine, Umbilical and Fetal Middle Cerebral Arteries in Patients with Chronic Placental Insufficiency: A Prospective RCT

“…As shown by a study conducted by Nakatsuka M et al, the PI in the umbilical artery was significantly reduced by treatment with NO donors with p-value <0.004 [7]. Similar results were observed in studies done on preeclamptic women by Dawoud MF et al and Thaler I et al [8,9].…”

“…Similar results were observed in a study conducted by Nakatsuka M et al, where a diastolic notch in the uterine artery flow velocity waveform, diminished or became smaller during administration of Isosorbide Dinitrate (ISDN). The PI was significantly reduced by treatment [7]. As shown by a study performed by Dawoud MF et al, there was significant decrease in S/D ratio (p<0.05) and RI (p<0.05) of uterine artery in preeclamptic subgroup treated with NTG patches compared to preeclamptic subgroup undergone expectant treatment [8].…”

“…The SBP remained at this level until last patch was removed [6]. In studies done by Nakatsuka M et al, and Grunewald C et al, the SBP of women was significantly suppressed during treatment [7,13]. Hartung J et al, did a study constituting severe preeclampsia group using glyceryl trinitrate in which it observed significant reduction in SBP (p<0.05) [4].…”

“…Nakatsuka M et al, conducted a study in which it was found that no significant changes occored in the PI in the MCA but the ratio of the PI of the umbilical artery over the PI of the MCA, which also indicates fetal hypoxia, was significantly reduced by treatment with transdermal ISDN (p<0.003) [7].…”

Vascular Dysfunction in Women with Recurrent Pregnancy Loss

“…The introduction of pulsed Doppler ultrasonography has provided noninvasive means for the evaluation of uterine impedance, and gives physiologic data, rather than anatomic information alone. It is known that resistance to uterine arterial blood flow is associated with poor obstetrical outcome such as preeclampsia and fetal growth restriction (Nakatsuka et al, 1999b;Nakatsuka et al, 2002;Takata et al, 200).…”