الفهرس 
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Abstract
Summary
Intrauterine growth restriction (IUGR) is a common and complex obstetric problem. IUGR is noted to affect approximately 10-15 % of pregnant women . IUGR is a diagnosis commonly made antenatally; however, some of these fetuses, especially if unscreened during pregnancy, may be detected only in the newborn period. It is very important for obstetricians and perinatologists to recognize growth-restricted fetuses, because this fetal condition is associated with significant perinatal morbidity and mortality (Suhag and Berghella ;2013)
We have done randomized controlled trial (RCT) to evaluate the effect of sildenafil citrate therapy on early and late onset severe intrauterine growth restriction.
A total of 46 patients with early and late onset intrauterine growth restriction were enrolled in the study . They were divided into 2 groups with 23 patients in each as follows:
Study group (Sildenafil group): We offered Sildenafil citrate (20 mg orally three times daily until delivery) as innovative therapy to 23 women with severe IUGR in addition to low dose aspirin, fish oil, antioxidants, beta agonist and zinc supplementation.
Placebo group: We offered placebo which is a vitamin the same in shape and texture as SC in addition to low dose aspirin, fish oil, antioxidants, beta agonist and zinc supplementation to 23 women with severe IUGR.
Each patient was instructed for bed rest and nutritional supplementation in addition to excessive oral fluid intake around the time of each tablet ingestion.
Uteroplacental perfusion was measured by Doppler velocimetry (umbilical & middle cerebral arteries) ,Fetal growth (Abdominal circumference ) and maternal and fetal safety .
Two still births were encountered among the sildenafil group while five still births were encountered in control group . The control group didn’t have a statistically significant change over time (p-value> 0.05). On contrast the mean AC-GV of sildenafil group increased significantly over time (p-value<0.001). So this concludes that this noticeably increase of AC-GV among sildenafil group is due to sildenafil.
Sildenafil citrate can improve utero-placental perfusion in pregnancies
complicated by IUGR. It appears to have a significantly positive effects on abdominal circumference growth in the immediate time period following the initiation of therapy. Sildenafil treatment may offer a new opportunity to improve perinatal outcomes, for pregnancies complicated by IUGR. However these observations require further studies on wide scale.