Fetal and neonatal outcomes after synergism between sildenafil citrate and nifidipine in patients with threatened preterm labour

Abstract

Objective: The aim of the work is to detect the risk of adding sildenafil citrate to nifedipine for
tocolysis on the fetal and neonatal outcomes in patients with threatened preterm labour.
Methods: This Included 192 pregnant women who suffered from threatened preterm labor. They
were divided into two groups, group (A) included 96 cases who received Nifedipine only and
group (B) included 96 cases who received Nifedipine with Sildenafil Citrate. Patients were be
randomly allocated to receive either (1) Nifedipine 20 mg orally (stat dose), followed by 10 mg
orally every 6 hours at the same time as oral administration of Sildenafil Citrate 20 mg at 8-
hourly intervals or (2) Nifedipine alone. Medications continued for 48–72 hours. During therapy,
fetal heart rate monitoring was performed every 30 minutes during the first 4 hours following the
start of therapy, then every 4 hours during the rest of the treatment. At delivery, all data
regarding labour, neonatal birth weight, neonatal APGAR score, neonatal respiratory distress,
need for incubator and neonatal death, all were documented and analysed.
Results: there was no statistically significant difference between the two studied groups as
regard age, BMI, gestational age on admission, cervical length on admission, cervical dilatation
on admission, no statistically significant difference between the two studied groups in fetal heart
rate . There is statistically significant difference between the studied groups regarding neonatal
birth weight (higher in combined nifedipine and sildenafil group). Also was no statistically
significant difference between the two studied groups as regard fetal outcome and the occurrence
of neonatal infection but with more neonatal respiratory distress among the nifedipine with
sildenafil group.
Conclusions: combination between nifedipine and sildenafil citrate have a better fetal outcome
according to neonatal birth weight but with poor outcome according to neonatal respiratory
distress in comparison to nifedipine alone in patients with threatened preterm labour.