Volume 6, Issue 2 (2025)                   J Clinic Care Skill 2025, 6(2): 105-111 | Back to browse issues page

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Asadikalameh Z, Golshahi Chamandani F, Sharifi M. Effect of Sildenafil on Fetal Heart Rate Pattern During Labor. J Clinic Care Skill 2025; 6 (2) :105-111
URL: http://jccs.yums.ac.ir/article-1-400-en.html
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1- Department of Gynecology and Obstetrics, Faculty of Medical, Yasuj University of Medical Sciences, Yasuj, Iran
2- “Student Research Committee” and “Faculty of Medical”, Yasuj University of Medical Sciences, Yasuj, Iran
3- Department of Midwifery, Faculty of Medical, Yasuj University of Medical Sciences, Yasuj, Iran
* Corresponding Author Address: Department of Midwifery, Faculty of Medical, Yasuj University of Medical Sciences, Shahid Jalil street, next to Imam Sajjad hospital, Yasuj, Iran. Postal Code: 7591994799 (dr.msharifi75@gmail.com)
Abstract   (514 Views)
Aims: Fetal heart rate patterns are monitored throughout pregnancy and labor to evaluate the health of the fetus. We aimed to evaluate the impact of sildenafil on fetal heart rate patterns during delivery.
Materials & Methods: This single-blind randomized controlled trial was conducted on 198 participants in the maternity unit of Imam Sajjad Hospital, Yasuj, in 2024. In addition to standard practices during labor, the intervention group received oral sildenafil at a dose of 50mg every 8 hours, not exceeding 150mg, starting with the initial dose at the onset of the study. In the control group, standard routine care was implemented. The primary outcome measure was fetal heart rate patterns, while the secondary outcome measures included labor duration, meconium-stained amniotic fluid, delivery method, postpartum hemorrhage, Apgar score, admission to the neonatal intensive care unit, and adverse effects.
Findings: Ninety-six cases in the sildenafil group and 102 cases in the control group were included in the analysis. The reassuring fetal heart rate pattern was more common in the sildenafil group (80.2% vs. 56.9%). Among the various non-reassuring fetal heart rate patterns, tachycardia and bradycardia were more prevalent in the control group than in the sildenafil group. Cesarean sections occurred more frequently in the control group than in the sildenafil group. The neonatal outcomes were similar in both groups, and no side effects were reported.
Conclusion: Sildenafil improves non-reassuring fetal heart rate patterns, especially tachycardia and bradycardia, and decreases the rate of cesarean deliveries.
 
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References
1. Lear CA, Westgate JA, Ugwumadu A, Nijhuis JG, Stone PR, Georgieva A, et al. Understanding fetal heart rate patterns that may predict antenatal and intrapartum neural injury. Semin Pediatr Neurol. 2018;28:3-16. [Link] [DOI:10.1016/j.spen.2018.05.002]
2. Vintzileos AM, Smulian JC. Abnormal fetal heart rate patterns caused by pathophysiologic processes other than fetal acidemia. Am J Obstet Gynecol. 2023;228(5S):S1144-57. [Link] [DOI:10.1016/j.ajog.2022.05.002]
3. Lear CA, Ugwumadu A, Bennet L, Gunn AJ. An update of our understanding of fetal heart rate patterns in health and disease. Semin Pediatr Neurol. 2023;47:101072. [Link] [DOI:10.1016/j.spen.2023.101072]
4. Roozbeh N, Montazeri F, Farashah MV, Mehrnoush V, Darsareh F. Proposing a machine learning-based model for predicting nonreassuring fetal heart. Sci Rep. 2025;15(1):7812. [Link] [DOI:10.1038/s41598-025-92810-2]
5. Nageotte MP. Fetal heart rate monitoring. Semin Fetal Neonatal Med. 2015;20(3):144-8. [Link] [DOI:10.1016/j.siny.2015.02.002]
6. Cartledge J, Eardley I. Sildenafil. Expert Opin Pharmacother. 1999;1(1):137-47. [Link] [DOI:10.1517/14656566.1.1.137]
7. Ghofrani HA, Osterloh IH, Grimminger F. Sildenafil: From angina to erectile dysfunction to pulmonary hypertension and beyond. Nat Rev Drug Discov. 2006;5(8):689-702. [Link] [DOI:10.1038/nrd2030]
8. Ahmed WS, Geethakumari AM, Biswas KH. Phosphodiesterase 5 (PDE5): Structure-function regulation and therapeutic applications of inhibitors. Biomed Pharmacother. 2021;134:111128. [Link] [DOI:10.1016/j.biopha.2020.111128]
9. Kass DA, Champion HC, Beavo JA. Phosphodiesterase type 5: Expanding roles in cardiovascular regulation. Circ Res. 2007;101(11):1084-95. [Link] [DOI:10.1161/CIRCRESAHA.107.162511]
10. Dilworth MR, Andersson I, Renshall LJ, Cowley E, Baker P, Greenwood S, et al. Sildenafil citrate increases fetal weight in a mouse model of fetal growth restriction with a normal vascular phenotype. PLoS One. 2013;8(10):e77748. [Link] [DOI:10.1371/journal.pone.0077748]
11. Oyston C, Stanley JL, Oliver MH, Bloomfield FH, Baker PN. Maternal administration of sildenafil citrate alters fetal and placental growth and fetal-placental vascular resistance in the growth-restricted ovine fetus. Hypertension. 2016;68(3):760-7. [Link] [DOI:10.1161/HYPERTENSIONAHA.116.07662]
12. Samangaya RA, Mires G, Shennan A, Skillern L, Howe D, McLeod A, et al. A randomised, double-blinded, placebo-controlled study of the phosphodiesterase type 5 inhibitor sildenafil for the treatment of preeclampsia. Hypertens Pregnancy. 2009;28(4):369-82. [Link] [DOI:10.3109/10641950802601278]
13. Trapani A, Gonçalves LF, Trapani TF, Vieira S, Pires M, Pires MMS. Perinatal and hemodynamic evaluation of sildenafil citrate for preeclampsia treatment: A randomized controlled trial. Obstet Gynecol. 2016;128(2):253-9. [Link] [DOI:10.1097/AOG.0000000000001518]
14. Mohammadi E, Noei Teymoordash S, Norouzi AR, Norouzi F, Norouzi HR. Comparison of the effect of nifedipine alone and the combination of nifedipine and sildenafil in delaying preterm labor: A randomized clinical trial. J Family Reprod Health. 2021;15(2):112-7. [Link] [DOI:10.18502/jfrh.v15i2.6452]
15. Turner J, Dunn L, Tarnow-Mordi W, Flatley C, Flenady V, Kumar S. Safety and efficacy of sildenafil citrate to reduce operative birth for intrapartum fetal compromise at term: A phase 2 randomized controlled trial. Am J Obstet Gynecol. 2020;222(5):401-14. [Link] [DOI:10.1016/j.ajog.2020.01.025]
16. Cuschieri S. The CONSORT statement. Saudi J Anaesth. 2019;13(Suppl 1):S27-30. [Link] [DOI:10.4103/sja.SJA_559_18]
17. The American College of Obstetricians and Gynecologists. ACOG practice bulletin No. 106: Intrapartum fetal heart rate monitoring: Nomenclature, interpretation, and general management principles. Obstet Gynecol. 2009;114(1):192-202. [Link] [DOI:10.1097/AOG.0b013e3181aef106]
18. Villanueva-García D, Mota-Rojas D, Hernández-González R, Sánchez-Aparicio P, Alonso-Spilsbury M, Trujillo-Ortega ME, et al. A systematic review of experimental and clinical studies of sildenafil citrate for intrauterine growth restriction and pre-term labour. J Obstet Gynaecol. 2007;27(3):255-9. [Link] [DOI:10.1080/01443610701194978]
19. Reynolds LP, Caton JS, Redmer DA, Grazul-Bilska AT, Vonnahme KA, Borowicz PP, et al. Evidence for altered placental blood flow and vascularity in compromised pregnancies. J Physiol. 2006;572(Pt 1):51-8. [Link] [DOI:10.1113/jphysiol.2005.104430]
20. Redmer DA, Wallace JM, Reynolds LP. Effect of nutrient intake during pregnancy on fetal and placental growth and vascular development. Domest Anim Endocrinol. 2004;27(3):199-217. [Link] [DOI:10.1016/j.domaniend.2004.06.006]
21. Reynolds LP, Borowicz PP, Caton JS, Vonnahme KA, Luther JS, Buchanan DS, et al. Uteroplacental vascular development and placental function: An update. Int J Dev Biol. 2010;54(2-3):355-66. [Link] [DOI:10.1387/ijdb.082799lr]
22. Rahimi F, Safavi Ardabili N, Asgharpoor H, Darsareh F. Effects of single-course betamethasone on the outcomes of late preterm neonates. Cureus. 2023;15(10):e46672. [Link] [DOI:10.7759/cureus.46672]
23. Darsareh F, Ranjbar A, Farashah MV, Mehrnoush V, Shekari M, Jahromi MS. Application of machine learning to identify risk factors of birth asphyxia. BMC Pregnancy Childbirth. 2023;23(1):156. [Link] [DOI:10.1186/s12884-023-05486-9]
24. Shekari M, Jahromi MS, Ranjbar A, Mehrnoush V, Darsareh F, Roozbeh N. The incidence and risk factors of meconium amniotic fluid in singleton pregnancies: an experience of a tertiary hospital in Iran. BMC Pregnancy Childbirth. 2022;22(1):930. [Link] [DOI:10.1186/s12884-022-05285-8]
25. Ranjbar A, Mehrnoush V, Darsareh F, Pariafsay F, Shirzadfardjahromi M, Shekari M. The incidence and outcomes of late-term pregnancy. Cureus. 2023;15(1):e33550. [Link] [DOI:10.7759/cureus.33550]
26. Rezaei Ghamsari S, Taeidi E, Darsareh F, Mehrnoush V. Analysis of cesarean section rates in a public tertiary hospital during teaching and non-teaching periods using the Robson ten group classification system. Cureus. 2023;15(8):e43838. [Link] [DOI:10.7759/cureus.43838]
27. Kumar S, Tarnow-Mordi W, Mol BW, Flenady V, Liley HG, Badawi N, et al. Intrapartum sildenafil to improve perinatal outcomes: A randomized clinical trial. JAMA. 2025;334(2):149-59. [Link] [DOI:10.1001/jama.2025.7710]
28. Dunn L, Greer R, Flenady V, Kumar S. Sildenafil in pregnancy: A systematic review of maternal tolerance and obstetric and perinatal outcomes. Fetal Diagn Ther. 2017;41(2):81-8. [Link] [DOI:10.1159/000453062]
29. Mehrnoush V, Ranjbar A, Banihashemi F, Darsareh F, Shekari M, Shirzadfardjahromi M. Urban-rural differences in the pregnancy-related adverse outcome. Gynecol Obstet Clin Med. 2023;3(1):51-5. [Link] [DOI:10.1016/j.gocm.2022.12.001]
30. Darsareh F, Aghamolaei T, Rajaei M, Madani A. Determinants of caesarean birth on maternal demand in the Islamic Republic of Iran: A review. East Mediterr Health J. 2017;23(6):441-8. [Link] [DOI:10.26719/2017.23.6.441]