Intra‐amniotic digoxin for feticide between 21 and 30 weeks of gestation: a prospective study

• Published in: BJOG : an international journal of obstetrics and gynaecology 2019-06, Vol.126 (7), p.885-889
• Main Authors: Sharvit, M, Klein, Z, Silber, M, Pomeranz, M, Agizim, R, Schonman, R, Fishman, A
• Format: Article
• Language: English
• Subjects: Abortion, Induced - methods; Adult; Amnion; Anti-Arrhythmia Agents - administration & dosage; Anti-Arrhythmia Agents - adverse effects; Chorioamnionitis; Digoxin; Digoxin - administration & dosage; Digoxin - adverse effects; EKG; Electrocardiography; Female; Fetal Death; fetal demise; Fetuses; Gestational age; Humans; Injection; Injections; medical termination of pregnancy; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Prospective Studies; second trimester; termination of pregnancy; Ultrasound
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.15640

Objective Intra‐amniotic injection of digoxin is a well‐known method for feticide before inducing a termination of pregnancy (TOP) at 17–24 weeks of gestation. Information on its effectiveness when administered after 24 weeks of gestation is limited. This study evaluated the efficacy of intra‐amniotic digoxin injection for inducing fetal demise within 18–24 hours, at 21–30 weeks of gestation, and its safety. Design Prospective cohort study. Setting Tertiary university medical centre. Population Women at 21–30 weeks of gestation with a singleton pregnancy, admitted for TOP. Methods Intra‐amniotic injection of 2 mg of digoxin was performed 1 day before medical TOP. Fetal heart activity was evaluated by ultrasound for 18–24 hours after the injection. Serum digoxin level and maternal electrocardiogram (ECG) were evaluated 6, 10, and 20 hours after injection. Main outcome measure Frequency of successful fetal demise. Results Fifty‐nine women participated in the study. The mean gestational age was 24+2 weeks (range 21+0–30+0), with 29 (49.2%) beyond 24+0 weeks of gestation. Fetal cardiac activity arrest was achieved in 55/59 cases (93.2%). Normal maternal ECG recordings were noted in all cases. Mean serum digoxin levels 6 and 10 hours after injection were in the therapeutic range (1.3 ± 0.7 ng/l and 1.24 ± 0.49 ng/l, respectively) and below the toxic level (2 ng/l). Extramural delivery following digoxin did not occur. There were no cases of chorioamnionitis. Conclusion Intra‐amniotic digoxin for feticide at 21–30 weeks of gestation in a singleton pregnancy appears effective and safe before TOP at advanced gestational ages. Tweetable This study shows that feticide by intra‐amniotic digoxin injection at 21–30 weeks of gestation appears effective and safe. Tweetable This study shows that feticide by intra‐amniotic digoxin injection at 21–30 weeks of gestation appears effective and safe.