Comparison between transdermal nitroglycerin and sildenafil citrate in intrauterine growth restriction: effects on uterine, umbilical and fetal middle cerebral artery pulsatility indices
Objectives To evaluate the effects of transdermal nitroglycerin (GTN) and sildenafil citrate on Doppler velocity waveforms of the uterine (UtA), umbilical (UA) and fetal middle cerebral (MCA) arteries in pregnancies with intrauterine growth restriction (IUGR). Methods This was a prospective study of...
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| Veröffentlicht in: | Ultrasound in obstetrics & gynecology 2016-07, Vol.48 (1), p.61-65 |
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| creator | Trapani, A. Gonçalves, L. F. Trapani, T. F. Franco, M. J. Galluzzo, R. N. Pires, M. M. S. |
| description | Objectives
To evaluate the effects of transdermal nitroglycerin (GTN) and sildenafil citrate on Doppler velocity waveforms of the uterine (UtA), umbilical (UA) and fetal middle cerebral (MCA) arteries in pregnancies with intrauterine growth restriction (IUGR).
Methods
This was a prospective study of 35 singleton pregnancies (gestational age, 24–31 weeks) with IUGR and abnormal UtA and UA Doppler waveforms. We compared maternal arterial blood pressure and Z‐scores of the pulsatility index (PI) of UtA, UA and fetal MCA before and after application of a transdermal GTN patch (average dose, 0.4 mg/h), oral sildenafil citrate (50 mg) or placebo. Statistical analysis was performed by ANOVA for paired samples.
Results
There was a significant decrease in UtA‐PI after application of GTN (21.0%) and sildenafil citrate (20.4%). A significant reduction in UA‐PI was also observed for both GTN (19.1%) and sildenafil citrate (18.2%). There was no difference in UtA‐ and UA‐PI when the GTN and sildenafil groups were compared. No changes in Doppler velocimetry were observed in the placebo group and no significant change in MCA‐PI was observed in any group. Maternal arterial blood pressure decreased with administration of both GTN and sildenafil citrate in those with pre‐eclampsia.
Conclusion
The use of transdermal GTN or sildenafil citrate in pregnancies with IUGR is associated with a significant reduction in both UtA and UA Doppler PI, as well as maternal arterial blood pressure. Neither drug affected the MCA‐PI. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. |
| doi_str_mv | 10.1002/uog.15673 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_1808660405</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4107904361</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3873-91d47d76e97b1f7cabdac6d10cf91ca1695538fc616e473c440048a75be1d3c03</originalsourceid><addsrcrecordid>eNqNkkFr3DAQhUVpabZJDv0DRdBLD3EysmXJ7i0sTRoI5NKcjSyNtwqyvJVkFv-1_rrKybaHnnKaB-9jHsM8Qj4yuGQA5dU87S5ZLWT1hmwYF20BEuq3ZAOtgEKKtjwhH2J8AgDBK_GenJSilC1nbEN-b6dxr4KNk6c9pgOipykoHw2GUTnqbQrTzi0ag_VUeUOjdQa9GqyjOpsqIc2O9VnOaaWQ7sJ0SD9pwJiC1clO_ivFYUCdIs05R-yCzmNvndU5Zl08YMpqtMY4pDkP-7A6IdML3c8uqpTptOQsYzXGM_JuUC7i-XGeksebbz-234v7h9u77fV9oatGVkXLDJdGCmxlzwapVW-UFoaBHlqmFRNtXVfNoAUTyGWlOQfgjZJ1j8xUGqpT8uVl7z5Mv-Z8UzfaqNE55XGaY8caaIQADvVr0JLLpmZtRj__hz5Nc_D5kJViApoSykx9OlJzP6Lp9sGOKizd3wdm4OoFOFiHyz-fQbc2o8vN6J6b0T0-3D6L6g8lWK-j</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1801608202</pqid></control><display><type>article</type><title>Comparison between transdermal nitroglycerin and sildenafil citrate in intrauterine growth restriction: effects on uterine, umbilical and fetal middle cerebral artery pulsatility indices</title><source>Wiley Free Content</source><source>Wiley Online Library - AutoHoldings Journals</source><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Trapani, A. ; Gonçalves, L. F. ; Trapani, T. F. ; Franco, M. J. ; Galluzzo, R. N. ; Pires, M. M. S.</creator><creatorcontrib>Trapani, A. ; Gonçalves, L. F. ; Trapani, T. F. ; Franco, M. J. ; Galluzzo, R. N. ; Pires, M. M. S.</creatorcontrib><description>Objectives
To evaluate the effects of transdermal nitroglycerin (GTN) and sildenafil citrate on Doppler velocity waveforms of the uterine (UtA), umbilical (UA) and fetal middle cerebral (MCA) arteries in pregnancies with intrauterine growth restriction (IUGR).
Methods
This was a prospective study of 35 singleton pregnancies (gestational age, 24–31 weeks) with IUGR and abnormal UtA and UA Doppler waveforms. We compared maternal arterial blood pressure and Z‐scores of the pulsatility index (PI) of UtA, UA and fetal MCA before and after application of a transdermal GTN patch (average dose, 0.4 mg/h), oral sildenafil citrate (50 mg) or placebo. Statistical analysis was performed by ANOVA for paired samples.
Results
There was a significant decrease in UtA‐PI after application of GTN (21.0%) and sildenafil citrate (20.4%). A significant reduction in UA‐PI was also observed for both GTN (19.1%) and sildenafil citrate (18.2%). There was no difference in UtA‐ and UA‐PI when the GTN and sildenafil groups were compared. No changes in Doppler velocimetry were observed in the placebo group and no significant change in MCA‐PI was observed in any group. Maternal arterial blood pressure decreased with administration of both GTN and sildenafil citrate in those with pre‐eclampsia.
Conclusion
The use of transdermal GTN or sildenafil citrate in pregnancies with IUGR is associated with a significant reduction in both UtA and UA Doppler PI, as well as maternal arterial blood pressure. Neither drug affected the MCA‐PI. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.</description><identifier>ISSN: 0960-7692</identifier><identifier>EISSN: 1469-0705</identifier><identifier>DOI: 10.1002/uog.15673</identifier><identifier>PMID: 26279411</identifier><identifier>CODEN: UOGYFJ</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Administration, Cutaneous ; Adult ; Blood Flow Velocity - drug effects ; Doppler ultrasonography ; Double-Blind Method ; Female ; fetal growth restriction ; Fetal Growth Retardation - diagnostic imaging ; Fetal Growth Retardation - drug therapy ; Fetal Growth Retardation - physiopathology ; Humans ; Middle Cerebral Artery - drug effects ; Middle Cerebral Artery - embryology ; Middle Cerebral Artery - physiology ; nitroglycerin ; Nitroglycerin - administration & dosage ; Nitroglycerin - pharmacology ; phosphodiesterase inhibitors ; Placental Insufficiency - diagnostic imaging ; Placental Insufficiency - drug therapy ; Placental Insufficiency - physiopathology ; Pregnancy ; Prospective Studies ; Pulsatile Flow - drug effects ; sildenafil citrate ; Sildenafil Citrate - administration & dosage ; Sildenafil Citrate - pharmacology ; Treatment Outcome ; Ultrasonography, Prenatal ; Umbilical Arteries - drug effects ; Umbilical Arteries - physiology ; Uterine Artery - drug effects ; Uterine Artery - physiology ; Vasodilator Agents - administration & dosage ; Vasodilator Agents - pharmacology ; Young Adult</subject><ispartof>Ultrasound in obstetrics & gynecology, 2016-07, Vol.48 (1), p.61-65</ispartof><rights>Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3873-91d47d76e97b1f7cabdac6d10cf91ca1695538fc616e473c440048a75be1d3c03</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fuog.15673$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fuog.15673$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26279411$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Trapani, A.</creatorcontrib><creatorcontrib>Gonçalves, L. F.</creatorcontrib><creatorcontrib>Trapani, T. F.</creatorcontrib><creatorcontrib>Franco, M. J.</creatorcontrib><creatorcontrib>Galluzzo, R. N.</creatorcontrib><creatorcontrib>Pires, M. M. S.</creatorcontrib><title>Comparison between transdermal nitroglycerin and sildenafil citrate in intrauterine growth restriction: effects on uterine, umbilical and fetal middle cerebral artery pulsatility indices</title><title>Ultrasound in obstetrics & gynecology</title><addtitle>Ultrasound Obstet Gynecol</addtitle><description>Objectives
To evaluate the effects of transdermal nitroglycerin (GTN) and sildenafil citrate on Doppler velocity waveforms of the uterine (UtA), umbilical (UA) and fetal middle cerebral (MCA) arteries in pregnancies with intrauterine growth restriction (IUGR).
Methods
This was a prospective study of 35 singleton pregnancies (gestational age, 24–31 weeks) with IUGR and abnormal UtA and UA Doppler waveforms. We compared maternal arterial blood pressure and Z‐scores of the pulsatility index (PI) of UtA, UA and fetal MCA before and after application of a transdermal GTN patch (average dose, 0.4 mg/h), oral sildenafil citrate (50 mg) or placebo. Statistical analysis was performed by ANOVA for paired samples.
Results
There was a significant decrease in UtA‐PI after application of GTN (21.0%) and sildenafil citrate (20.4%). A significant reduction in UA‐PI was also observed for both GTN (19.1%) and sildenafil citrate (18.2%). There was no difference in UtA‐ and UA‐PI when the GTN and sildenafil groups were compared. No changes in Doppler velocimetry were observed in the placebo group and no significant change in MCA‐PI was observed in any group. Maternal arterial blood pressure decreased with administration of both GTN and sildenafil citrate in those with pre‐eclampsia.
Conclusion
The use of transdermal GTN or sildenafil citrate in pregnancies with IUGR is associated with a significant reduction in both UtA and UA Doppler PI, as well as maternal arterial blood pressure. Neither drug affected the MCA‐PI. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.</description><subject>Administration, Cutaneous</subject><subject>Adult</subject><subject>Blood Flow Velocity - drug effects</subject><subject>Doppler ultrasonography</subject><subject>Double-Blind Method</subject><subject>Female</subject><subject>fetal growth restriction</subject><subject>Fetal Growth Retardation - diagnostic imaging</subject><subject>Fetal Growth Retardation - drug therapy</subject><subject>Fetal Growth Retardation - physiopathology</subject><subject>Humans</subject><subject>Middle Cerebral Artery - drug effects</subject><subject>Middle Cerebral Artery - embryology</subject><subject>Middle Cerebral Artery - physiology</subject><subject>nitroglycerin</subject><subject>Nitroglycerin - administration & dosage</subject><subject>Nitroglycerin - pharmacology</subject><subject>phosphodiesterase inhibitors</subject><subject>Placental Insufficiency - diagnostic imaging</subject><subject>Placental Insufficiency - drug therapy</subject><subject>Placental Insufficiency - physiopathology</subject><subject>Pregnancy</subject><subject>Prospective Studies</subject><subject>Pulsatile Flow - drug effects</subject><subject>sildenafil citrate</subject><subject>Sildenafil Citrate - administration & dosage</subject><subject>Sildenafil Citrate - pharmacology</subject><subject>Treatment Outcome</subject><subject>Ultrasonography, Prenatal</subject><subject>Umbilical Arteries - drug effects</subject><subject>Umbilical Arteries - physiology</subject><subject>Uterine Artery - drug effects</subject><subject>Uterine Artery - physiology</subject><subject>Vasodilator Agents - administration & dosage</subject><subject>Vasodilator Agents - pharmacology</subject><subject>Young Adult</subject><issn>0960-7692</issn><issn>1469-0705</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkkFr3DAQhUVpabZJDv0DRdBLD3EysmXJ7i0sTRoI5NKcjSyNtwqyvJVkFv-1_rrKybaHnnKaB-9jHsM8Qj4yuGQA5dU87S5ZLWT1hmwYF20BEuq3ZAOtgEKKtjwhH2J8AgDBK_GenJSilC1nbEN-b6dxr4KNk6c9pgOipykoHw2GUTnqbQrTzi0ag_VUeUOjdQa9GqyjOpsqIc2O9VnOaaWQ7sJ0SD9pwJiC1clO_ivFYUCdIs05R-yCzmNvndU5Zl08YMpqtMY4pDkP-7A6IdML3c8uqpTptOQsYzXGM_JuUC7i-XGeksebbz-234v7h9u77fV9oatGVkXLDJdGCmxlzwapVW-UFoaBHlqmFRNtXVfNoAUTyGWlOQfgjZJ1j8xUGqpT8uVl7z5Mv-Z8UzfaqNE55XGaY8caaIQADvVr0JLLpmZtRj__hz5Nc_D5kJViApoSykx9OlJzP6Lp9sGOKizd3wdm4OoFOFiHyz-fQbc2o8vN6J6b0T0-3D6L6g8lWK-j</recordid><startdate>201607</startdate><enddate>201607</enddate><creator>Trapani, A.</creator><creator>Gonçalves, L. F.</creator><creator>Trapani, T. F.</creator><creator>Franco, M. J.</creator><creator>Galluzzo, R. N.</creator><creator>Pires, M. M. S.</creator><general>John Wiley & Sons, Ltd</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>201607</creationdate><title>Comparison between transdermal nitroglycerin and sildenafil citrate in intrauterine growth restriction: effects on uterine, umbilical and fetal middle cerebral artery pulsatility indices</title><author>Trapani, A. ; Gonçalves, L. F. ; Trapani, T. F. ; Franco, M. J. ; Galluzzo, R. N. ; Pires, M. M. S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3873-91d47d76e97b1f7cabdac6d10cf91ca1695538fc616e473c440048a75be1d3c03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Administration, Cutaneous</topic><topic>Adult</topic><topic>Blood Flow Velocity - drug effects</topic><topic>Doppler ultrasonography</topic><topic>Double-Blind Method</topic><topic>Female</topic><topic>fetal growth restriction</topic><topic>Fetal Growth Retardation - diagnostic imaging</topic><topic>Fetal Growth Retardation - drug therapy</topic><topic>Fetal Growth Retardation - physiopathology</topic><topic>Humans</topic><topic>Middle Cerebral Artery - drug effects</topic><topic>Middle Cerebral Artery - embryology</topic><topic>Middle Cerebral Artery - physiology</topic><topic>nitroglycerin</topic><topic>Nitroglycerin - administration & dosage</topic><topic>Nitroglycerin - pharmacology</topic><topic>phosphodiesterase inhibitors</topic><topic>Placental Insufficiency - diagnostic imaging</topic><topic>Placental Insufficiency - drug therapy</topic><topic>Placental Insufficiency - physiopathology</topic><topic>Pregnancy</topic><topic>Prospective Studies</topic><topic>Pulsatile Flow - drug effects</topic><topic>sildenafil citrate</topic><topic>Sildenafil Citrate - administration & dosage</topic><topic>Sildenafil Citrate - pharmacology</topic><topic>Treatment Outcome</topic><topic>Ultrasonography, Prenatal</topic><topic>Umbilical Arteries - drug effects</topic><topic>Umbilical Arteries - physiology</topic><topic>Uterine Artery - drug effects</topic><topic>Uterine Artery - physiology</topic><topic>Vasodilator Agents - administration & dosage</topic><topic>Vasodilator Agents - pharmacology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Trapani, A.</creatorcontrib><creatorcontrib>Gonçalves, L. F.</creatorcontrib><creatorcontrib>Trapani, T. F.</creatorcontrib><creatorcontrib>Franco, M. J.</creatorcontrib><creatorcontrib>Galluzzo, R. N.</creatorcontrib><creatorcontrib>Pires, M. M. S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Ultrasound in obstetrics & gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Trapani, A.</au><au>Gonçalves, L. F.</au><au>Trapani, T. F.</au><au>Franco, M. J.</au><au>Galluzzo, R. N.</au><au>Pires, M. M. S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison between transdermal nitroglycerin and sildenafil citrate in intrauterine growth restriction: effects on uterine, umbilical and fetal middle cerebral artery pulsatility indices</atitle><jtitle>Ultrasound in obstetrics & gynecology</jtitle><addtitle>Ultrasound Obstet Gynecol</addtitle><date>2016-07</date><risdate>2016</risdate><volume>48</volume><issue>1</issue><spage>61</spage><epage>65</epage><pages>61-65</pages><issn>0960-7692</issn><eissn>1469-0705</eissn><coden>UOGYFJ</coden><abstract>Objectives
To evaluate the effects of transdermal nitroglycerin (GTN) and sildenafil citrate on Doppler velocity waveforms of the uterine (UtA), umbilical (UA) and fetal middle cerebral (MCA) arteries in pregnancies with intrauterine growth restriction (IUGR).
Methods
This was a prospective study of 35 singleton pregnancies (gestational age, 24–31 weeks) with IUGR and abnormal UtA and UA Doppler waveforms. We compared maternal arterial blood pressure and Z‐scores of the pulsatility index (PI) of UtA, UA and fetal MCA before and after application of a transdermal GTN patch (average dose, 0.4 mg/h), oral sildenafil citrate (50 mg) or placebo. Statistical analysis was performed by ANOVA for paired samples.
Results
There was a significant decrease in UtA‐PI after application of GTN (21.0%) and sildenafil citrate (20.4%). A significant reduction in UA‐PI was also observed for both GTN (19.1%) and sildenafil citrate (18.2%). There was no difference in UtA‐ and UA‐PI when the GTN and sildenafil groups were compared. No changes in Doppler velocimetry were observed in the placebo group and no significant change in MCA‐PI was observed in any group. Maternal arterial blood pressure decreased with administration of both GTN and sildenafil citrate in those with pre‐eclampsia.
Conclusion
The use of transdermal GTN or sildenafil citrate in pregnancies with IUGR is associated with a significant reduction in both UtA and UA Doppler PI, as well as maternal arterial blood pressure. Neither drug affected the MCA‐PI. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>26279411</pmid><doi>10.1002/uog.15673</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| issn | 0960-7692 1469-0705 |
| language | eng |
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| source | Wiley Free Content; Wiley Online Library - AutoHoldings Journals; MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Administration, Cutaneous Adult Blood Flow Velocity - drug effects Doppler ultrasonography Double-Blind Method Female fetal growth restriction Fetal Growth Retardation - diagnostic imaging Fetal Growth Retardation - drug therapy Fetal Growth Retardation - physiopathology Humans Middle Cerebral Artery - drug effects Middle Cerebral Artery - embryology Middle Cerebral Artery - physiology nitroglycerin Nitroglycerin - administration & dosage Nitroglycerin - pharmacology phosphodiesterase inhibitors Placental Insufficiency - diagnostic imaging Placental Insufficiency - drug therapy Placental Insufficiency - physiopathology Pregnancy Prospective Studies Pulsatile Flow - drug effects sildenafil citrate Sildenafil Citrate - administration & dosage Sildenafil Citrate - pharmacology Treatment Outcome Ultrasonography, Prenatal Umbilical Arteries - drug effects Umbilical Arteries - physiology Uterine Artery - drug effects Uterine Artery - physiology Vasodilator Agents - administration & dosage Vasodilator Agents - pharmacology Young Adult |
| title | Comparison between transdermal nitroglycerin and sildenafil citrate in intrauterine growth restriction: effects on uterine, umbilical and fetal middle cerebral artery pulsatility indices |
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