Effectiveness of pentoxifylline in severe early-onset fetal growth restriction: A randomized double-blinded clinical trial.

Autor:	Asadi N; Maternal-fetal medicine Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: nasadi2012@yahoo.ca., Roozmeh S; Maternal-fetal medicine Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: dr.roozmeh1995@yahoo.com., Vafaei H; Maternal-fetal medicine Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: Vafaeih@gmail.com., Asmarian N; Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: Ns.asmarian@gmail.com., Jamshidzadeh A; Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran. Electronic address: ajamshid@sums.ac.ir., Bazrafshan K; Maternal-fetal medicine Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: bazrafshan.kh@gmail.com., Kasraeian M; Maternal-fetal medicine Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: maryamkasraeian@gmail.com., Faraji A; Maternal-fetal medicine Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: farajiaz@sums.ac.ir., Shiravani Z; Maternal-fetal medicine Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: shiravanizahra63@gmail.com., Mokhtar Pour A; Fellow of the Royal College of Pathologists Australasia (FRCPA), Department of Histopathology, Faculty of Medicine, UKM Medical Center, Kuala Lumpur, Malaysia. Electronic address: dramtp79@gmail.com., Alamdarloo SM; Maternal-fetal medicine Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: shaghayeghmoradi84@gmail.com., Abdi N; Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Electronic address: Abdinazanin834@gmail.com., Gharibpour F; Maternal-fetal medicine Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: samiragh17@yahoo.com., Izze S; Hafez Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: mahmoudiums@yahoo.com.
Jazyk:	angličtina
Zdroj:	Taiwanese journal of obstetrics & gynecology [Taiwan J Obstet Gynecol] 2022 Jul; Vol. 61 (4), pp. 612-619.
DOI:	10.1016/j.tjog.2021.12.003
Abstrakt:	Objective: Management of pregnancy complicated by severe early-onset fetal growth restriction (FGR) is one of the most challenging obstetrical issues. So far, there has not been a proven option for the treatment or improvement of this condition. Improper immune response during placentation leads to inadequate trophoblast invasion and impaired utero-placental perfusion. Pentoxifylline improves the endothelial function and induces vasodilation by reducing the inflammatory-mediated cytokines. We have evaluated the effect of Pentoxifylline on fetal-placental perfusion, neonatal outcome, and the level of oxidative stress markers before and after the intervention in the setting of severe early-onset FGR. Materials and Methods: This study is a pilot randomized clinical trial on 40 pregnant women who had developed early-onset growth restricted fetus. Pentoxifylline and placebo were given with a dose of 400 mg per os two times daily until delivery. Serial ultrasound examination regarding fetal weight, amniotic fluid and also utero-placenta-fetal Doppler's were done. For the assessment of serum Antioxidant level, blood sampling was done once at the beginning of the study and again, at least, three weeks after the investigation. After delivery, umbilical-cord blood gas analysis, APGAR score at 1 and 5 min, NICU admission, and neonatal death were recorded and compared between the two groups. Results: Utero-placenta-fetal Doppler's in the Pentoxifylline group did not significantly change compared to the control group. Fetal weight gain was significantly higher in the Pentoxifylline group before (996.33 ± 317.41) and after (1616.89 ± 527.90) treatment (P = 0.002). Total serum antioxidant capacity significantly increased in the Pentoxifylline group (p < 0.036). Average 5 min Apgar score was significantly higher (P < 0.036) and the percentage of babies admitted to NICU was significantly lower (P < 0.030) in the treated group. Conclusion: Using Pentoxifylline in pregnancy affected by FGR might show promising effects. In this study, Pentoxifylline improved the neonatal outcome, increased fetal weight gain, and reduced neonatal mortality by decreasing the level of oxidative stress markers and cutting down the inflammatory cascade. Competing Interests: Declaration of competing interest There is no conflict of interest to be declared regarding the manuscript. (Copyright © 2022. Published by Elsevier B.V.)
Databáze:	MEDLINE
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