Sildenafil citrate to improve colour doppler indices in patient with pre-eclampsia: a path less taken
Abstract
A 38-year-old primigravida with poor ovarian reserve, history of one failed self in vitro fertilization (IVF) cycle and treated genital Koch’s conceived with donor oocyte IVF. She was on Aspirin 150 mg and 40 units of low molecular weight heparin post embryo transfer in view of absent blood flow in zone 3 and 4 according to Applebaum's staging and the same were continued in pregnancy. Her nuchal thickness ultrasonography (NT scan) at 12.2 weeks of gestation was negative for any anomalies but showed bilateral uterine arteries with diastolic notch and increased resistance. Her level 3 ultrasound at 18 weeks of gestation did not show any major malformation. However, uterine artery mean PI was increased to 1.95 (normal range up to 1.4). Bilateral uterine arteries showed increased resistance (right-1.5 and left-2.4). Fetal 2D echo at 24 weeks of gestation showed increased S/D ratio of the left uterine artery to 9.3. Intensive monitoring was done biweekly and she was started on nitric oxide donor (L-arginine) 3 gm daily. However, at 28 weeks of gestation she developed pregnancy induced hypertension (PIH) and was started on tablet labetalol 100 mg thrice a day. Her colour doppler ultrasound showed estimated baby weight (EBW) of 1.133 kg with normal amniotic fluid index (AFI) but absent diastolic flow (Figure 1). Started her on tablet sildenafil citrate 25 mg vaginally thrice a day after counseling the patient and her husband. Injection betamethasone 2 doses were given. She was…
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