title: Late termination of pregnancy by intracardiac potassium chloride injection: 5 years' experience at a tertiary referral centre.
abstract: OBJECTIVE
  To report our experience with intracardiac potassium chloride (KCl) injection as a method of feticide for severe congenital abnormalities beyond 24 weeks' gestation.
  
  
  METHODS
  A retrospective chart review. Patient demographics and types of fetal anomalies were analysed according to the groups that accepted or declined late termination of pregnancy (LTOP, ≥24 weeks) for severe congenital abnormalities.
  
  
  RESULTS
  Of 3 896 women referred to the Fetal Medicine Unit at Inkosi Albert Luthuli Central Hospital, KwaZulu-Natal, 2 209 (56.7%) were at ≥24 weeks' gestation at their first visit. LTOP for severe congenital abnormalities was offered to 253 (11.5%), of whom 191 (75.5%) accepted. Differences in maternal age, parity, race and religion were not statistically significant. The type of fetal abnormalities and gestational age at diagnosis influenced the decision-making process in >80% of the women. The most frequent indications for LTOP were brain and spinal abnormalities (53.0%), and aneuploidy (20.6%). Feticide by ultrasound-guided intracardiac KCl injection was performed in 138/191 cases (72.2%); 53 women who accepted LTOP did not undergo feticide for a variety of reasons. The mean interval between diagnosis and performance of feticide was 10 days (range 0 - 42 days). Fetal asystole was achieved in all cases within 2 minutes by a single-needle injection of intracardiac KCl; the mean duration of the procedure was 12 minutes (range 6 - 25 minutes). There were no maternal complications, and stillbirths occurred in all cases.
  
  
  CONCLUSIONS
  Feticide by ultrasound-guided intracardiac KCl injection was an acceptable, safe and effective method for LTOP. Further studies are needed to determine the minimum dosage of KCl required to achieve the desired effect.
authors.affiliation: Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, Durban, South Africa. govenderl18@ukzn.ac.za
authors.forename: L
authors.initials: L
authors.lastname: Govender
authors.forename: J
authors.initials: J
authors.lastname: Moodley
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000028:Abortion, Induced / Q000379:methods*; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006321:Heart; D006801:Humans; D007267:Injections; D011189:Potassium Chloride / Q000008:administration & dosage*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D012017:Referral and Consultation; D012189:Retrospective Studies; D013019:South Africa; D013997:Time Factors
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D011189:Potassium Chloride