Treatment using tadalafil for dichorionic diamniotic twin pregnancy with fetal growth restriction

Fetal growth restriction (FGR) is the most important cause of perinatal morbidity and mortality in developed countries. Clinicians are often forced to end the pregnancy due to fetal indications, inflicting iatrogenic prematurity on a fetus with associated high risk of adverse neonatal outcomes. Here, the authors report a case of dichorionic diamniotic (DD) twin pregnancy with FGR whose pregnancy was successfully prolonged using tadalafil, a phosphodiesterase 5 inhibitor. A 22-year-old primigravid woman presented at 25 5/7 weeks of gestation with DD twin pregnancy with FGR. Tadalafil administration was begun at this time. Her pregnancy was prolonged by 90 days after initiation of tadalafil. Tadalafil may be a novel treatment to prolong the period of pregnancy in cases of DD twin pregnancy with FGR and threatened premature labor.