When Poonkudi and S Sunderraj hold the christening ceremony of their daughter next week, their silent thanks to the Lord may also include a grateful word about sildenafil. Sildenafil is a drug better known as the sexual performance-enhancing Viagra, but in this case it's not what you're thinking.
A few months ago, when Poonkudi's blood pressure kept rising, leading to a perilous situation for the child, it was the unconventional use of sildenafil that clicked. Her doctors at Jaslok Hospital say if she managed to deliver a live child after four ill-fated pregnancies, it's Viagra's desi clones that deserve a pat on the back.
It is not unheard-of for medicines to be used aggressively or innovatively in life-and-death matters in ICU settings; so, the blue sildenafil tablet, which is only meant to correct erectile dysfunction in men, was in this case used to sustain an extremely difficult pregnancy. "It is perhaps the first time that it has been used to prolong a pregnancy dogged by hypertension,'' said nephrologist Dr Madan M Bahadur of Jaslok Hospital.
Poisur resident Poonkudi's story began over six months ago. The 27-year-old wife of an electrician came to gynaecologist Dr Sudeshna Ray on the recommendation of a parish friend. "At 221/150, her blood pressure was high when she came to us at three-and-a-half months of pregnancy,'' said Dr Ray. Almost immediately the rush to keep the pregnancy going began: Poonkudi was confined to hospital, with round-the-clock monitoring and tests.
A detailed examination revealed her problem—a narrowed right renal artery that was causing blood pressure to build up.
According to Dr Bahadur, every known anti-hypertensive drug was prescribed to Poonkudi in over the usual dosage. A procedure to put a stent in the shrunken artery was abandoned, as it was found to be unfeasible. That is when Dr Bahadur drew upon his previous experience with sildenafil.
"We had previously used sildenafil for a 14-year-old girl who had kidney failure and had a hypertension emergency in the intensive care unit,'' he told TOI.The June 2005 edition of the Nephrology, Dialysis and Transplant Journal has chronicled Dr Bahadur's earlier case of how the Jaslok team had, for the first time in medical history, used sildenafil along with sodium nitroprusside to manage the fast-sinking girl, who finally stabilised. She is now a healthy person living with a transplanted kidney.
Thus, in the 24th week of Poonkudi's pregnancy, sildenafil was started in double the usually recommended dosage, said Dr Bahadur. "We then managed to get her pressure down to acceptable limits,'' he added. It still wasn't smooth sailing; resident doctors and nurses were worried throughout Poonkudi's four-month hospital stay about a possible convulsion brought on by the rising pressure.
Said Dr Ray, "We had to do extensive research using journals, we talked to experts abroad to ascertain the dosages and we were worried about the child's condition in her mother's womb.'' To ensure that she didn't have pre-eclampsia (very high blood pressure with high protein in urine that needs urgent Caesarean section), weekly Doppler and sonography checks were done.
In the 29th week, the daily Doppler test showed high resistance in blood flow patterns. "So within 24 hours, we operated, and her daughter, weighing just 940 grams, was born,'' she added.
A few months ago, when Poonkudi's blood pressure kept rising, leading to a perilous situation for the child, it was the unconventional use of sildenafil that clicked. Her doctors at Jaslok Hospital say if she managed to deliver a live child after four ill-fated pregnancies, it's Viagra's desi clones that deserve a pat on the back.
It is not unheard-of for medicines to be used aggressively or innovatively in life-and-death matters in ICU settings; so, the blue sildenafil tablet, which is only meant to correct erectile dysfunction in men, was in this case used to sustain an extremely difficult pregnancy. "It is perhaps the first time that it has been used to prolong a pregnancy dogged by hypertension,'' said nephrologist Dr Madan M Bahadur of Jaslok Hospital.
Poisur resident Poonkudi's story began over six months ago. The 27-year-old wife of an electrician came to gynaecologist Dr Sudeshna Ray on the recommendation of a parish friend. "At 221/150, her blood pressure was high when she came to us at three-and-a-half months of pregnancy,'' said Dr Ray. Almost immediately the rush to keep the pregnancy going began: Poonkudi was confined to hospital, with round-the-clock monitoring and tests.
A detailed examination revealed her problem—a narrowed right renal artery that was causing blood pressure to build up.
According to Dr Bahadur, every known anti-hypertensive drug was prescribed to Poonkudi in over the usual dosage. A procedure to put a stent in the shrunken artery was abandoned, as it was found to be unfeasible. That is when Dr Bahadur drew upon his previous experience with sildenafil.
"We had previously used sildenafil for a 14-year-old girl who had kidney failure and had a hypertension emergency in the intensive care unit,'' he told TOI.The June 2005 edition of the Nephrology, Dialysis and Transplant Journal has chronicled Dr Bahadur's earlier case of how the Jaslok team had, for the first time in medical history, used sildenafil along with sodium nitroprusside to manage the fast-sinking girl, who finally stabilised. She is now a healthy person living with a transplanted kidney.
Thus, in the 24th week of Poonkudi's pregnancy, sildenafil was started in double the usually recommended dosage, said Dr Bahadur. "We then managed to get her pressure down to acceptable limits,'' he added. It still wasn't smooth sailing; resident doctors and nurses were worried throughout Poonkudi's four-month hospital stay about a possible convulsion brought on by the rising pressure.
Said Dr Ray, "We had to do extensive research using journals, we talked to experts abroad to ascertain the dosages and we were worried about the child's condition in her mother's womb.'' To ensure that she didn't have pre-eclampsia (very high blood pressure with high protein in urine that needs urgent Caesarean section), weekly Doppler and sonography checks were done.
In the 29th week, the daily Doppler test showed high resistance in blood flow patterns. "So within 24 hours, we operated, and her daughter, weighing just 940 grams, was born,'' she added.
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