Digoxin to facilitate late second-trimester abortion: a randomized, masked, placebo-controlled trial.
OBJECTIVE
To examine the efficacy of digoxin for decreasing operative time, difficulty, and pain of late second-trimester surgical abortions.


METHODS
We performed a randomized, double-masked, placebo-controlled trial of intra-amniotic digoxin for second-trimester dilation and evacuation (D&E) involving 126 consecutive women at an inner-city public hospital. Eligible women had gestational ages of 20-23.1 weeks, spoke English or Spanish, and were at least 16 years old. Digoxin (1 mg) or saline was injected intra-amniotically 24 hours before the procedure, at cervical laminaria insertion. The primary outcome was procedure duration. Sample size was based on 80% power to detect a difference of 3.5 minutes between groups.


RESULTS
The two groups were similar in demographic factors, obstetric histories, and gestational duration. The average gestational length was 22.5 weeks. There was no difference in procedure duration (mean +/- standard deviation) between groups (placebo 14.7 +/- 7.0, digoxin 15.4 +/- 8.0). There were no differences in blood loss estimated by surgeons, pain scores, procedure difficulty scores, or complications between groups. Vomiting was significantly more common in those who received digoxin (placebo 3.1%, digoxin 16.1%). Most subjects (91%) reported that they preferred their fetuses were dead before the abortions.


CONCLUSIONS
Although digoxin did not increase efficacy of late second-trimester abortion, patient preference might justify its use.
Center for Reproductive Health Research and Policy, San Francisco General Hospital, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California 94110, USA. rjack@itsa.ucsf.edu
R A
RA
Jackson
V L
VL
Teplin
E A
EA
Drey
L J
LJ
Thomas
P D
PD
Darney
D000019:Abortifacient Agents / Q000008:administration & dosage*; D000028:Abortion, Induced; D000293:Adolescent; D000328:Adult; D000653:Amniotic Fluid; D004077:Digoxin / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D017060:Patient Satisfaction; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D013997:Time Factors
D000019:Abortifacient Agents; D004077:Digoxin