The Effect of Sildenafil Citrate on Fetal and Maternal Ultrasound Indices in IUGR-complicated Pregnancies; A Systematic Review and Meta-analysis of Randomized Clinical Trials
Abstract
Intrauterine growth restriction (IUGR) is a common complication of pregnancy and is associated with a higher risk of perinatal mortality and morbidity. We aimed to systematically review the studies that evaluated the efficacy of sildenafil citrate on improving the ultrasonographic changes in the middle cerebral artery (MCA) and umbilical artery (UA) in pregnancies complicated with IUGR. We performed a systematic search of PubMed, Scopus, Embase, Pro-Quest, Web of Science, and Google scholar (from inception to 30 June 2020), of randomized clinical studies evaluating the efficacy of sildenafil citrate on different outcomes of IUGR-complicated pregnancies. Mean differences (SD) were extracted and pooled using random and fixed effects models based on their heterogeneity. Six studies were identified for quantitative meta-analysis. Seven outcomes, including MCA resistive index (RI)، MCA pulsatility index (PI)، MCA systolic to the diastolic ratio (S/D), UA RI، UA PI، UA S/D, and cerebroplacental ratio (CPR) have been evaluated in these studies. The pooled results for the efficacy of treatment on MCA RI (Pooled MD = 0.07, 95% CI:0.03 to 0.1,p-value < 0.001) and MCA S/D (Pooled MD = 0.8, 95% CI0.18 to 0.45,p-value < 0.001) were statistically significant. The changes in other outcomes were comparable between the study groups. Overall, our meta-analysis on RCT showed that sildenafil citrate might improve MCA RI and MCA S/D in IUGR-complicated pregnancies. Regarding the other outcomes,…
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