Background: Severe early-onset intrauterine growth restriction increases the risk of perinatal morbidity and mortality, particularly as a result of iatrogenic premature delivery. It complicates approximately 0.2% of pregnancies.

Aim of the work: The aim of the study is to compare the effect of oral sildenafil citrate 20 mg and oral nitroglycerin 2.5 mg in cases of intrauterine growth restriction.
Patients and Methods: This prospective observational study was performed on a total of 100 pregnant normotensive females diagnosed with IUGR in Al-Hussein University Hospitals and Dar Ismail Hospital for Obstetrics and gynecology, Alexandria, Egypt, from May 2020 to May 2021.

Results: there was no significant difference between the two studied groups according to age. Mean (±SD) age in years for group I is 26.20 ± 2.75 and 26.70 ± 3.16 for group II. P value is 0.439. There was no significant difference between the two studied groups according to body mass index (BMI). Mean (±SD) BMI (kg/m2) for group I is 35.51 ± 3.55 and 34.59 ± 3.27 for group II. P value is 0.182. There was statistically significant difference between the two studied groups regarding parity. There was significant difference in both groups before treatment and after 14 days of treatment according to biparietal diameter (BPD) in mm.

Conclusion: The study concluded that a high significance of using oral Sildenafil citrate and oral Nitroglycerin in the treatment of cases of asymmetrical IUGR, as a significant increase in placental blood flow, observed from decreasing the uterine and umbilical arteries Doppler indices.