Comparison of Sildenafil Citrate plus Hydration with Hydration Alone In Terms Of Amniotic Fluid Index Improvement in Idiopathic Oligohydramnios during Third Trimester of Pregnancy

Abstract

Objective: To compare the effectiveness of sildenafil citrate plus hydration with hydration alone in improving amniotic fluid index (AFI) among women with idiopathic oligohydramnios in the third trimester.

Methodology: This randomized controlled trial was conducted at Sir Ganga Ram Hospital, Lahore, over six months from September 2022 to February 2023. Sixty women aged 18–35 years with singleton pregnancies at 30–34 weeks of gestation, AFI <5 cm, and normal umbilical artery Doppler indices were randomly allocated into two groups. Group A received sildenafil citrate 25 mg orally every 8 hours plus 2 L intravenous Ringer’s lactate over 4 hours, while Group B received 2 L intravenous Ringer’s lactate alone. Both groups were encouraged to maintain oral hydration and followed weekly until 37 weeks, with serial ultrasound assessment of AFI.

Results: The mean maternal age was 26.55±5.05 years and mean gestational age was 32.52±1.43 weeks. AFI was significantly higher in the sildenafil plus hydration group than in the hydration-alone group after 48 hours (5.03±3.40 vs. 3.97 cm; p=0.001) and remained significantly higher during follow-up. Birth weight was also significantly greater in Group A than Group B (2855.37±88.93 vs. 2629.40±72.69 g; p=0.001). Low Apgar scores (<7) were less frequent in Group A than Group B (10.0% vs. 33.3%; p=0.001). No significant differences were observed in gestational age, mode of delivery, or maternal adverse effects (p>0.05).

Conclusion: Sildenafil citrate combined with hydration significantly improved AFI and neonatal outcomes compared with hydration alone, without a significant increase in maternal adverse effects