Comparative Study Between Effect of Sildenafil Citrate and Acetylsalicylic Acid and Clexane on Uteroplacental Perfusion in Intrauterine Growth Restriction

Background: Numerous studies suggested that since sildenafil citrate enhances the endothelial function of myometrial arteries in these women, it may provide a viable treatment approach to increase uteroplacental blood flow in pregnancies complicated by FGR. Aim and objectives: To compare how acetylsalicylic acid, clexane, and sildenafil citrate affect uteroplacental perfusion in intrauterine growth restriction. Subjects and methods: Three pregnant woman groups were involved in the study, and a computer was randomly assigned to the groups. Group 1 consists of thirty pregnant women who will get treatment twice daily for six weeks with sildenafil citrate tab 20 mg (Respatio, MPI Company). Group 2 consists of thirty pregnant women who will receive treatment for six weeks with a 40 mg syringe of enoxaparin sodium (Clexane, Sanofi Comp.) administered subcutaneously once daily. Group 3: 30 expectant mothers will receive treatment with a 75 mg tab of acetylsalicylic acid (Aspirin, ID comp.) once a day for six weeks. Then, after the medicine was administered to each group and across groups, determine the primary endpoint Doppler changes (pulsatility index (PI), resistance index (RI), or systolic/diastolic (S/D) ratio) that happened in each of the vessels tested (uterine, umbilical, or MCA): delivery challenges, neonatal morbidity and death, further related abnormalities, and newborns' APGAR rating. Result: Regarding estimated fetal weight (EFW) upon admission, there were no appreciable variations between the groups under study (P>0.05). After six weeks, the group taking sildenafil citrate experienced a more significant increase in EFW than the other groups. Additionally, among the three groups under study, EFW increased significantly after six weeks compared to admission (P<0.001). Conclusion: Our findings indicate that the combination of sildenafil, heparin, and aspirin is more effective in treating growth-restricted fetuses than any medication alone, as seen by improvements in fetal growth indices and a decrease in NICU hospitalizations. While all treatment choices are determined to be equally effective, sildenafil has a more significant number of adverse effects even when it is tolerated.