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

Gupta, Sanjeev; Chauhan, Meenakshi; Sen, Jyotsna; Nanda, Smiti

doi:10.7860/jcdr/2017/21438.10282

Cited by 5 publications

(4 citation statements)

References 23 publications

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“…The APGAR score reflects the newborn's hypoxemic status during the stress of labor. It is a reliable predictor of the fetus's placental reserve, particularly in IUGR pregnancies (30). The current study , in the Sildenafil group, In the Nitroglycerin group, Only 11 women had a 1 minute APGAR score of 7 and 7 women had a 5 minute APGAR score of 7.…”

Section: Age (Years)mentioning

confidence: 58%

Comparative study between the effect of oral sildenafil citrate versus oral nitroglycerin on intrauterine growth restriction in normotensive pregnant women.

El‐Haddad

Ahmed²,

Galal³

2022

Al-Azhar International Medical Journal

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Background: Severe perinatal morbidity and mortality are increased by severe early-onset intrauterine growth restriction., especially when combined with iatrogenic premature delivery. It causes complications in about 0.2 percent of pregnancies. Small-for-gestation newborns have birth weights or lengths that are less than the 10th percentile for gender and gestational age., and these babies are constitutionally small. Aim of the work: To compare the effects of oral sildenafil citrate 20 mg and oral nitroglycerin 2.5 mg in normotensive pregnant females with intrauterine growth restriction (IUGR). Patients and methods: This prospective observational study was performed on a total of 100 pregnant normotensive females diagnosed with IUGR in Al-Hussein University Hospitals and Dar Ismail Hospital for Obstetrics and gynecology, Alexandria, Egypt, from May 2020 to May 2021 with inclusion and exclusion criteria. Results:The age disparity between the two study groups was not statistically significant. The mean (standard deviation) age in years for group I is 26.20 2.75 and 26.70 3.16 for group II. The P-value is 0.439. In terms of body mass index, there was no significant difference between the two groups studied (BMI). The mean (standard deviation) BMI (kg/m2) for group I is 35.51 3.55 and 34.59 3.27 for group II. The probability is 0.182. There was a statistically significant difference in parity between the two groups studied. According to biparietal diameter (BPD) in mm, Before and after 14 days of treatment, there was a significant difference in both groups. There was a significant difference in both groups' head circumference (HC) in mm before and after 14 days of treatment. There was a significant difference in both groups' abdominal circumference (AC) in mm before and after 14 days of treatment. The length of the femurs differed significantly.(FL) in both groups before and after 14 days of treatment. Conclusion:The current study concluded that using oral Sildenafil citrate and oral Nitroglycerin in the treatment of asymmetrical IUGR has a high significance, By reducing the uterine and umbilical arteries, a significant increase in placental blood flow was observed . Doppler characteristics.Sildenafil citrate may be preferred over oral Nitroglycerin due to fewer side effects.

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Section: Age (Years)mentioning

confidence: 58%

Comparative study between the effect of oral sildenafil citrate versus oral nitroglycerin on intrauterine growth restriction in normotensive pregnant women.

El‐Haddad

Ahmed²,

Galal³

2022

Al-Azhar International Medical Journal

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“… 12 Furthermore, in IUGR fetuses with AREDV, there is an increased expression of estrogen receptor-β within the fetoplacental endothelium, misbalancing the vascular tonus mediators and favoring vasoconstriction. 1 54 55 Being a vasodilator and smooth muscle relaxant, 56 the administration of intravenous or transdermal nitroglycerine causes a decrease in placental resistance to flow. This results in decreased PI, RI and S/D ratio in UA and Uterine artery (UtA) Doppler US, thus improving the outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…This results in decreased PI, RI and S/D ratio in UA and Uterine artery (UtA) Doppler US, thus improving the outcomes. 56 57 …”

Section: Resultsmentioning

confidence: 99%

Doppler Ultrasound of the Umbilical Artery: Clinical Application

Rocha

Andrade

Moleiro

et al. 2022

Rev Bras Ginecol Obstet

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Objective To provide a survey of relevant literature on umbilical artery Doppler ultrasound use in clinical practice, technical considerations and limitations, and future perspectives. Methods Literature searches were conducted in PubMed and Medline, restricted to articles written in English. Additionally, the references of all analyzed studies were searched to obtain necessary information. Results The use of this technique as a routine surveillance method is only recommended for high-risk pregnancies with impaired placentation. Meta-analyses of randomized trials have established that obstetric management guided by umbilical artery Doppler findings can improve perinatal mortality and morbidity. The values of the indices of Umbilical artery Doppler decrease with advancing gestational age; however, a lack of consensus on reference ranges prevails. Conclusion Important clinical decisions are based on the information obtained with umbilical artery Doppler ultrasound. Future efforts in research are imperative to overcome the current limitations of the technique.

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“…The beneficial role of NO donors in PE treatment was proved in a recent work by Gupta et al, who demonstrated an improvement in Doppler velocimetry in the umbilical artery and the uterine artery after using nitroglycerin in pregnant patients diagnosed with GH and FGR [ 33 ]. Similar results were obtained in the study conducted by Nakatsuka et al, in which an early diastolic notch was observed in the uterine artery [ 33 , 34 ]. However, these studies have not reported hemodynamic changes in the fetal middle cerebral artery.…”

Section: Discussionmentioning

confidence: 99%

Decrease in Nitric Oxide Production as a Key Mediator in the Pathogenesis of Preeclampsia and a Potential Therapeutic Target: A Case-Control Study

et al. 2022

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Pregnancy-induced hypertension (GH) complicates 6–10% of all pregnancies and, in 2019, was responsible for approximately 28,000 deaths. The most common cause of gestational hypertension is pre-eclampsia (PE), which afflicts 2–8% of all pregnancies and is one of the three leading causes of maternal morbidity and mortality worldwide. The aim of this study was to clarify how NO metabolism changes during the course of PE. Due to the short half-life of NO, we measured the concentrations of its stable metabolites, nitrite and nitrate (NOx). Out of 100 enrolled patients: 58 pregnant women with a diagnosed early form of PE formed a study group, and 42 healthy pregnant women formed a control group. NOx concentrations were significantly lower in the PE group than in the control group, with mean values of 5.33 and 27.64 μmol/L, respectively (p < 0.0001). The decrease in NO is most likely the result and mediator of systemic endothelial dysfunction. The impairment of NO metabolism in PE appears to play an important role in its pathogenesis. Therefore, it is a potential therapeutic target.

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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

Cited by 5 publications

References 23 publications

Comparative study between the effect of oral sildenafil citrate versus oral nitroglycerin on intrauterine growth restriction in normotensive pregnant women.

Comparative study between the effect of oral sildenafil citrate versus oral nitroglycerin on intrauterine growth restriction in normotensive pregnant women.

Doppler Ultrasound of the Umbilical Artery: Clinical Application

Decrease in Nitric Oxide Production as a Key Mediator in the Pathogenesis of Preeclampsia and a Potential Therapeutic Target: A Case-Control Study

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