Sildenafil Citrate Therapy for Oligohydramnios: A Randomized Controlled Trial

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Pharmacology

Background:

• Idiopathic oligohydramnios, defined as an amniotic fluid index (AFI) less than 5 cm without identifiable maternal or fetal causes, complicates singleton pregnancies.
• Management of idiopathic oligohydramnios often focuses on improving amniotic fluid volume and neonatal outcomes.

Purpose of the Study:

• To compare the efficacy of sildenafil citrate plus hydration versus hydration alone in improving the amniotic fluid index (AFI) and neonatal outcomes in pregnancies complicated by idiopathic oligohydramnios.

Main Methods:

• An open-label randomized trial involving women with singleton pregnancies at 30 weeks of gestation or more diagnosed with idiopathic oligohydramnios.
• Participants received either oral sildenafil citrate (25 mg every 8 hours) plus intravenous hydration or hydration alone until delivery.
• Primary outcome was amniotic fluid volume; secondary outcomes included duration of pregnancy, mode of delivery, and neonatal outcomes.

Main Results:

• The sildenafil group demonstrated a significantly higher final amniotic fluid volume (11.5 cm vs. 5.4 cm, P=.02).
• Pregnancies treated with sildenafil were prolonged (38.3 vs. 36.0 weeks, P=.001), with a reduced cesarean delivery rate (28% vs. 73%).
• Neonatal intensive care unit admissions were significantly lower in the sildenafil group (11% vs. 41%, P=.001).

Conclusions:

• Sildenafil citrate effectively increases amniotic fluid volume in pregnancies complicated by idiopathic oligohydramnios.
• Sildenafil administration in conjunction with hydration offers significant benefits for both maternal and neonatal outcomes in cases of idiopathic oligohydramnios.