الفهرس 
RECURRENT MISCARRIAGEOnly 14 pages are availabe for public view
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Abstract
The aim of this study was to evaluate the efficacy of oral sildenafil citrate 25 mg on uterine arteries Doppler flow studies in patients with unexplained recurrent miscarriages.
This prospective case control study was conducted at Ain Shams University Maternity Hospital outpatient clinics. The study included 180 women who were divided into 2 groups: (group 1) which included 91 patients who took sildenafil citrate 25 mg orally, 4 times per day for 21 days (Silden 25 mg tablet, EIPICO, Inc, Cairo, Egypt) and (group 2) which included 89 patients who took placebo orally, 4 times per day for 21 days in the period starting from (August 2011 to April 2012).
Our inclusion criteria was: age 18-35 years and ≥ 3 recurrent spontaneous abortions before the 24th week of gestation with no apparent cause for their previous losses and Three or more months have elapsed since the last abortion in Postmenstrual period and no other therapy allowed during our treatment course.
Our exclusion criteria was: Concomitant use of organic nitrites, or nitrates, any severe hepatic, renal, or cardiovascular impairment, history of stroke or myocardial infarction or patients with retinitis pigmentosa.
Every subject was subjected to verbal consent, detailed history to ensure our inclusion and exclusion criteria and Local examination to determine type of female genital mutilation and all women had systematic investigations according to the established protocol including hysterosalpingogram, coagulation profile, thyroid function test, pelvic ultrasound scan, anticardiolipin antibodies IgG and IgM, lupus anticoagulant antibodies, and hormonal analysis (including progesterone, prolactin, androgens, and early follicular FSH, and LH). And questionnaire about: arousal symptoms, libido and sexual desire, sexual performance and possible side effects including:
Common effects: headache, flushing, dyspepsia, nasal congestion, blurring of vision, photophobia, cyanopsia (blue vision), dizziness, postural hypotension, and urinary tract infection.
Other minor effects: palpitations, diarrhea, vomiting, sweating, backache, and arthralgia.
Rare serious effects: loss of peripheral vision, allergic reaction, sudden hearing loss, and chest pain.
Ultrasonography and pulsed Doppler blood flow assessments, using a Medison (Sonoace X6, South Korea) scanner with a transvaginal multifrequency probe, was performed 4 times, before intervention on weekly basis by the same operator, to measure maximum endometrial thickness, uterine arteries blood flow studies including: Systolic/ diastolic ratio, pulsatility index and resistance index.
Regarding our results there was no significant statistical difference between the two studied groups as regard age, duration of marriage, maternal smoking, previous labor, past history DM, circumcision.
Also, there was no statistical significant difference between the two studied groups as regard FSH, T3, T4, TSH, prolactin, anticardiolipin IgG, anticardiolipin IgM, PTT and INR but significance only in LH.
The statistical comparison between group I (Sildenafil Citrate) and group II (placebo) before administration of drug regarding female sexual function domains shows non significance but the comparison between group I (sildenafil citrate) and group II (placebo) after administration of drug regarding female sexual function domains shows significance in desire score, satisfaction score and total female sexual function index (FSFI) score.
Also the statistical comparison between before and after administration of drug in group I (sildenafil citrate) regarding female sexual function domains shows significance in arousal score, desire score, satisfaction score and total FSFI score but the statistical comparison between before and after administration of drug in group II (placebo) regarding female Sexual function domains shows non significance.
The statistical comparison between non circumcised and circumcised females before drug administration in all cases regarding FSFI shows non significance but the statistical comparison between non circumcised and circumcised females after drug administration in group I (sildenafil citrate) regarding FSFI shows significance in orgasm score and arousal score.
This statistical comparison between group I (sildenafil citrate) and group II (placebo) before administration of drug regarding expected sildenafil citrate side effects shows significance in flushing only but the statistical comparison between group I (sildenafil citrate) and group II (placebo) after administration of drug regarding expected sildenafil citrate side effects shows significance in headache only.
Also the statistical comparison in patients in group I (sildenafil citrate) before and after administration of drug regarding expected sildenafil citrate side effects shows significance in headache and palpitations and the statistical comparison in patients in group II (placebo) before and after administration of drug regarding expected sildenafil citrate side effects shows significance in dizziness, postural hypertension.
The statistical comparison between group I (Sildenafil Citrate) and group II (Placebo) before and after administration of drug regarding Endometrial thickness shows non significance before and significance after 3 weeks of administration of Sildenafil Citrate in group I and placebo in group II.
The statistical comparison in patients in group I (Sildenafil Citrate) before and after 1 week, 2 weeks and 3 weeks administration of drug regarding Pulsatility index, Resistance index and Systolic/ diastolic ratio shows significance in Pulsatility index, Resistance index and Systolic/ diastolic ratio.
In conclusion, sildenafil citrate has an effective role in increasing the uterine arteries blood flow in patients with recurrent miscarriage.