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 examine the effects of sildenafil citrate + hydration against hydration alone on
the improvement of the amniotic fluid index (AFI) in idiopathic oligohydramnios during the
third trimester of pregnancy.
Methods: This randomized controlled trial was done at Sir Ganga Ram Hospital, Lahore, on
60 pregnant women with singleton pregnancy, age range 18-35 years, gestational age (30-34
weeks), presented with mniotic fluid index less than 5 cm (idiopathic) and those having
umbilical artery Doppler study indices in normal range. Patients were randomly divided in two
groups. Tab Sildenafil citrate 25 mg per oral, every 8 hourly was given to the patients
enrolled in Group A along with administration of intravenous infusion of two litter of isotonic
solution over a period of four hours, while in group B patients received two liters of isotonic
solution (Ringer’s lactate) over a period of four hours during hospitalization for 48 hours and
observed for sign and symptoms of fluid overload and drugs side effects. Fluid therapy was
repeated after 24 hours of initial treatment. All the patients were encouraged for oral
hydration and ultrasound was done 48 hours of initial treatment for reevaluation of amniotic
fluid index. All the findings regarding the study variables were recorded in a specified
proforma and analyzed using SPSS version 25.
RESULTS: Mean age of the patients was 26.55±5.047 years and mean gestational age was
32.52±1.432 weeks. After 48 amniotic fluid was significantly higher in group A than group B
(5.03±3.40 cm, p- 0.001). Subsequently Group A had significantly higher fetal birth weight
(2855.37 ± 88.928 g vs. 2629.40 ± 72.685 g), and some cases of low Apgar score (<7) (10.0%
vs. 33.3%) compared to group B (p=0.001). However gestational age and mode of delivery
showed no significant difference across the groups. Moreover according to adverse effects,
only headache was significantly higher in Group A (16.7% vs. 0.0%), while flushing, allergic
reaction, gastritis, and hypotension did not showed significant association between-group (p >
0.05)
CONCLUSION: Sildenafil citrate combined with hydration approach proved proven to
be an effective in increasing mean AFI at various time intervals and also lead to higher
gestational age at the time of delivery and significantly higher fetal weight at birth.
KEY WORDS: AFI, Hydration, Oligohydramnios, Sildenafil Citrate.