Fetal intracardiac potassium chloride injection to avoid the hopeless resuscitation of an abnormal abortus: I. Clinical issues.
OBJECTIVE
With the intention of preventing the attendant medical, ethical, and legal problems arising from the birth of live-born, anomalous fetuses, we initiated a program offering fetal intracardiac potassium chloride injection as an adjunctive measure in the setting of genetically indicated second-trimester abortion.


METHODS
A lethal fetal injection was offered to patients carrying chromosomally or structurally abnormal fetuses at 19-24 weeks' gestation who desired abortion. When the patient elected this procedure, real-time ultrasound guidance was used to inject 3-5 mL of potassium chloride (2 mEq/mL) directly into the fetal cardiac chambers, followed by observation of fetal heart activity to ascertain cessation. Labor was subsequently induced with uterotonic prostaglandins.


RESULTS
The procedure caused immediate cessation of fetal heart motion in 20 of 21 cases. There were no maternal complications. No fetuses were live-born.


CONCLUSIONS
Direct fetal intracardiac potassium chloride injection effectively causes immediate fetal cardiac arrest. This approach may be adopted in cases of abortion by labor-induction methods at advanced gestations to ensure that the abortus is stillborn.
Isada
N B
NB
Department of Obstetrics/Gynecology, Hutzel Hospital/Wayne State University, Detroit, Michigan.
Pryde
P G
PG
Johnson
M P
MP
Hallak
M
M
Blessed
W B
WB
Evans
M I
MI
D000025:Abortion, Eugenic / Q000379:methods; D000013:Congenital Abnormalities / Q000628:therapy; D005260:Female; D005318:Fetal Heart; D006324:Heart Arrest, Induced; D006801:Humans; D007267:Injections; D007751:Labor, Induced; D011189:Potassium Chloride / Q000008:administration & dosage*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012151:Resuscitation
D011189:Potassium Chloride