Safety and Efficacy of Sildenafil Citrate to Reduce Operative Birth for Intrapartum Fetal Compromise at Term: A Phase 2 Randomized Controlled Trial

Abstract

(Am J Obstet Gynecol. 2020;222:401–414) Intrapartum fetal compromise, or fetal distress, is a major cause of perinatal death and hypoxic-ischemic encephalopathy in low- to middle-income countries, and causes 1 in 5 cases of cerebral palsy in high-income countries. The only proven interventions for intrapartum fetal compromise are emergency cesarean delivery or emergency delivery by instrumental vaginal birth, both of which carry significant risks. Sildenafil citrate increases fetal and uteroplacental blood flow and is an effective treatment for adult and newborn pulmonary hypertension. This study evaluated the efficacy and safety of sildenafil citrate in reducing the rate of emergency cesarean delivery or instrumental vaginal birth for intrapartum fetal distress.