Abstract
Background
The study was conducted to assess the effectiveness in inducing fetal demise through
digoxin injection given 1 day prior to second-trimester pregnancy termination and
to evaluate related maternal safety.
Study Design
A retrospective cohort analysis of 1795 pregnant women between 17 and 24 weeks' gestation
who received varying doses of digoxin by transabdominal intrafetal or intra-amniotic
injection at the time of laminaria placement was conducted. Fetal heart activity documented
by M-mode Doppler sonography on the subsequent day was considered failure. Digoxin
dosages started at 1.0 mg for intrafetal and 0.5 mg for intra-amniotic injections
and were progressively decreased based on best clinical judgment.
Results
The overall rate of failure to achieve fetal demise was 6.6% (95% CI, 5.5���7.9).
Failure rates varied according to route of administration and dosage. There were no
failures using a 1.0-mg intrafetal dose, but failures occurred with lower doses. Failure
rates were higher with 0.5 mg for intra-amniotic (8.3%) than intrafetal administration
(3.6%). There were no adverse maternal events at any of the doses in this study.
Conclusion
Intrafetal digoxin injection at a dose of 1.0 mg is safe and effective for fetal demise
prior to pregnancy termination in the second trimester. Significantly lower doses
are effective in most cases. Additional doses merit further testing.
Keywords
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References
- Laminaria, induced fetal demise and misoprostol in late abortion.Intern J Gynaecol Obstet. 2001; 75: 279-286
- Safety of intra-amniotic digoxin administration before late second-trimester abortion by dilation and evacuation.Am J Obstet Gynecol. 2000; 182: 1063-1066
- Digoxin to facilitate late second-trimester abortion: a randomized, masked, placebo-controlled trial.Obstet Gynecol. 2001; 97: 471-476
Article info
Publication history
Published online: January 21, 2008
Accepted:
October 30,
2007
Received in revised form:
October 29,
2007
Received:
September 1,
2007
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
