February 2019 · Volume 8 · Issue 2 Page 597 International Journal of Reproduction, Contraception, Obstetrics and Gynecology El-Ebshehy ES et al. Int J Reprod Contracept Obstet Gynecol. 2019 Feb;8(2):597-603 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 Original Research Article Effect of transdermal nitroglycerin patch on severe preeclamptic women with abnormal Doppler indices El-Sayed S. El-Ebshehy*, Ahmed M. Hagras, Amr T. Elbadry, Ahmed M. Awara INTRODUCTION Pre-eclampsia is one of the most serious pregnancy complications and, in its severe form, is one of the main causes of maternal and perinatal morbidity and mortality. Preeclampsia and eclampsia are among the three main causes of maternal mortality worldwide, affecting approximately 4.6% and 1.4% of all births, respectively. Preeclampsia is best described as a pregnancy-specific syndrome that can affect virtually every organ system although often chiefly includes the development of new- onset hypertension in the second half of pregnancy accompanied by new-onset proteinuria. The appearance of proteinuria remains an important diagnostic criterion. Thus, proteinuria is an objective marker and reflects the system-wide endothelial leak, which characterizes the preeclampsia syndrome. 1 The pathophysiology of pre-eclampsia has not yet been clearly established. But there is a consensus that endothelial dysfunction plays an important role in the pathogenesis of preeclampsia. 2,3 Endothelial dysfunction can be broadly defined as an imbalance between vasodilator and vasoconstrictor substances produced from the endothelium. 3 Among many endothelium-derived vasoactive factors, nitric oxide (NO) is a critical vessel- ABSTRACT Background: The aim is to evaluate the effect of maternal transdermal nitro-glycerine patch administration on blood flow resistance on maternal uterine artery, fetal umbilical and middle cerebral arteries in patients with severe pre- eclampsia in early gestational age (24 weeks to 33 weeks) associated with abnormal Doppler indices (placental insufficiency) and also its effect on maternal mean arterial blood pressure. Methods: This is a prospective interventional clinical trial conducted on (50) pregnant women with singleton pregnancy diagnosed with severe pre-eclampsia admitted in high-risk pregnancy unit at the Department of Obstetrics in Tanta University Hospitals, A 50-mg transdermal GTN patch (Novartis Pharma) was applied to the abdominal skin, releasing nitroglycerin at a rate of 0.4 mg/h. Doppler ultrasonography and measurement of maternal blood pressure were performed before application of transdermal GTN patch, after 4 hours of application, after 24 hours and after 48 hours. Results: the application of a 50-mg transdermal GTN patch to the maternal abdomen was associated with a significant decline in the PI of the uteroplacental and fetoplacental blood flow. No change was observed in the PI of the cerebral circulation. And also, there was a significant decrease in maternal blood pressure (MAP). Conclusions: Nitroderm patch (nitric oxide donors) may be used as initial therapy in cases of severe preeclampsia complicated by placental insufficiency in the form of abnormal Doppler indices. Keywords: Doppler ultrasound, Severe preeclampsia, Nitric oxide, Nitroderm patch Department of Obstetrics and Gynecology, Tanta University, Tanta, Egypt Received: 20 November 2018 Accepted: 29 December 2018 *Correspondence: Dr. El-Sayed S. El-Ebshehy, E-mail: dr.elsayed.samy@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20190291