A randomized pilot study on the effectiveness and side-effect profiles of two doses of digoxin as fetocide when administered intraamniotically or intrafetally prior to second-trimester surgical abortion.
BACKGROUND
Digoxin is commonly used to facilitate second-trimester surgical abortion despite limited data regarding its safety and effectiveness for this indication. We conducted a pilot study to determine the incidence of side effects after digoxin administration and whether effectiveness can be improved with variations in dose and technique.


METHODS
Fifty-two women presenting for elective termination of pregnancy between 18 and 24 weeks' gestation were randomized to one of four digoxin treatment groups: 1.0 mg intraamniotic (1.0 IA), 1.0 mg intrafetal (1.0 IF), 1.5 mg intraamniotic (1.5 IA) or 1.5 mg intrafetal (1.5 IF). Ultrasound was used to assess for the presence of fetal cardiac activity prior to the abortion procedure. Data on the presence and severity of pain, nausea and other potential side effects were collected before digoxin injection, immediately following digoxin injection and on the day after digoxin injection.


RESULTS
Digoxin effectively induced fetal death in 87% of women. The failure rate did not vary by route of administration (IA or IF) and was not lowered by increasing the dose from 1.0 to 1.5 mg. IF injections induced fetal death more rapidly than IA injections. Digoxin administration did not result in increased pain or nausea.


CONCLUSIONS
IA or IF injection of digoxin is safe and effective for inducing fetal death prior to second-trimester surgical abortion. Doses greater than 1.0 mg may not be necessary.
Nucatola
Deborah
D
Planned Parenthood, Los Angeles, CA 90033, USA. deb.nucatola@pp-la.org
Roth
Nitzan
N
Gatter
Mary
M
D000019:Abortifacient Agents / Q000008:administration & dosage / Q000009:adverse effects; D000028:Abortion, Induced / Q000379:methods*; D000293:Adolescent; D000328:Adult; D004077:Digoxin / Q000008:administration & dosage* / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D018579:Patient Selection; D010865:Pilot Projects; D011247:Pregnancy; D011262:Pregnancy Trimester, Second
D000019:Abortifacient Agents; D004077:Digoxin