title: Transvaginal administration of intraamniotic digoxin prior to dilation and evacuation.
abstract: BACKGROUND
  Transabdominal injection of digoxin into the amniotic fluid or fetus to induce fetal demise before dilation and evacuation (D&E) abortion has become common practice since the passage of the Partial-Birth Abortion Ban Act in 2007.
  
  
  METHODS
  We performed a prospective study to assess the feasibility of transvaginal administration of intraamniotic digoxin the day before D&E. All women between 18 0/7 and 23 5/7 weeks of gestation seeking termination from December 2009 to May 2011 were approached for study participation. Women who declined participation were asked to identify their primary rationale. For women declining study participation, transection of the umbilical cord during D&E was performed to meet the requirements of the ban.
  
  
  RESULTS
  Over 18 months, 134 women met study entry criteria and 108 (81%) declined to participate. Of the 26 women who enrolled, 1.0 mg undiluted digoxin was successfully administered transvaginally in 24 (92%, 95% confidence interval 75%-99%). The most common reasons for declining participation were discomfort with preoperatively inducing fetal demise (37%) and desire to avoid a medically unnecessary medication (36%).
  
  
  CONCLUSIONS
  Transvaginal administration of digoxin is a feasible alternative to transabdominal administration to induce preoperative fetal demise. The majority of women decline digoxin administration when an alternative is available.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA. aileen.gariepy@yale.edu
authors.forename: Aileen M
authors.initials: AM
authors.lastname: Gariepy
authors.forename: Beatrice A
authors.initials: BA
authors.lastname: Chen
authors.forename: Heather L
authors.initials: HL
authors.lastname: Hohmann
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Achilles
authors.forename: Jennefer A
authors.initials: JA
authors.lastname: Russo
authors.forename: Mitchell D
authors.initials: MD
authors.lastname: Creinin
mesh_terms: D000028:Abortion, Induced / Q000379:methods*; D000328:Adult; D000653:Amniotic Fluid; D016001:Confidence Intervals; D004077:Digoxin / Q000008:administration & dosage* / Q000009:adverse effects; D004107:Dilatation and Curettage; D005260:Female; D005313:Fetal Death / Q000139:chemically induced*; D005865:Gestational Age; D006801:Humans; D057240:Patient Preference / Q000523:psychology*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D014621:Vagina; D055815:Young Adult
chemical_list: D004077:Digoxin