الفهرس 
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Abstract
IUGR is defined as a pathological decrease in the rate of fetal growth below 10th percentile for age. It’s most common etiology is uteroplacental dysfunction. IUGR is symmetrical, asymmetrical or mixed.
IUGR is caused by maternal, placental, fetal or genetic factors. Various maternal factors such as age of the mother, inter-pregnancy interval (less than 6 months or 120 months or more), maternal health, behavioral habits and maternal infection affect the growth of the fetus and are responsible for causing IUGR.
The incidence of IUGR is six times higher in underdeveloped or developing countries when compared to that in developed countries.
In order to diagnose IUGR it is essential to estimate gestational age accurately. Although this is usually calculated from the last menstrual period, when known with certainty, the reliability of this estimate is low as timing of ovulation is variable. A first trimester ultrasound can date the pregnancy more reliably. Most accurately by Crown Rump Length (CRL) between 8 to 13 weeks (best 9 to 11 weeks).
Growth-restricted fetuses with severe impairment of umbilical artery blood flow are at increased risk of adverse outcomes such as intrauterine fetal demise (IUFD) and neonatal death, as well as increased neonatal morbidity, including hypoglycemia, hyperbilirubinemia, hypothermia, intraventricular hemorrhage, necrotizing enterocolitis, seizures, sepsis and respiratory distress syndrome.
The aim of this study was to evaluate the effect of LMWH alone and LMWH combined with oral sildenafil citrate on IUGR pregnant women and to compare between the two conditions.
A total of 78 patients were divided into 2 groups. Full physical and obstetric examination was done to all patients with ultrasound biometry (BPD, HC, AC, FL, EFW) and Doppler study of umbilical artery and middle cerebral artery (PSV, EDV, SD ratio, RI, PI).
group I received subcutaneous LMWH, dose according to their weight once daily and group II received the same drug combined with oral sildenafil citrate 20mg once daily for 14 days then follow up by ultrasound biometry and Doppler study was done. Follow up of patients every week till delivery and follow up of neonatal outcome was done.
The results showed improvement in ultrasound biometry and expected fetal weight after administration of both drugs more evident with group II. Also improvement in placental (uterine artery) and fetal blood flow (umbilical artery) as studied by Doppler ultrasound (decrease in PI & RI) was noticed after administration of drugs in both groups also more evident with group II.
No significant difference was found when comparing the two groups together. No significant difference between the two groups as regards time of delivery, route of delivery, Apgar score and neonatal outcome.