FETAL distress is one of the most frequent causes of emergency caesarean section (CS) due to insufficient uteroplacental blood supply. Recent research investigates the effectiveness of sildenafil citrate (SC) in reducing fetal distress and emergency CS during labour. Labour can reduce uteroplacental blood flow by up to 60%, increasing the risk of fetal distress, a significant cause of intrauterine fetal death and a major reason for emergency CS, a procedure associated with higher maternal and neonatal morbidities.
This randomised, double-blinded clinical trial included 208 pregnant women with singleton pregnancies between 37 and 41 weeks. Participants were randomly divided into two groups: the SC group, receiving 50 mg of sildenafil every six hours (n=104), and a placebo group (n=104). Upon arrival during the latent phase of labour, the first dose of the trial medication was administered and repeated every 6 hr, up to 3 times. Throughout the process, both the mother and fetus were monitored at intervals of 15 to 30 minutes. The primary outcomes assessed were fetal distress rates, mode of delivery (vaginal or CS), and neonatal health, measured by Apgar scores and umbilical artery pH.
The results showed that SC administration significantly reduced the need for emergency CS (12.5% in the SC group vs. 26% in the placebo group) and decreased the rate of FD by 53.8% (95% CI, 1-8.24; P=0.049). The SC group also had higher Apgar scores at 1 and 5 minutes, indicating better neonatal health. The mean haemoglobin levels six hours after delivery were higher in the SC group, reflecting reduced blood loss during labour. Additionally, there was no significant difference in labour duration or adverse effects, with only minor side effects such as headaches reported.
In conclusion, SC appears to be a safe and effective intervention for reducing FD and the need for emergency CS during labour. Larger trials are recommended to confirm these findings and explore its broader use in labour management.
Abigail Craig | EMJ
Reference
Sharami SH et al. Dose Sildenafil Citrate Reduce the Incidence of Emergency Cesarean Section and Fetal Distress During Labor? A Randomized Double-Blinded Clinical Trial. J Reprod Infertil. 2024; 25(1): 46-55.
