title: Effectiveness and safety of lidocaine in the induction of fetal cardiac asystole for second trimester pregnany termination.
abstract: The presence of a major congenital anomaly is a frequent indication for late termination of pregnancy. The possibility of the fetus being born alive is significant, thus, feticide prior to the procedure is desirable. The purpose of this study was to assess the safety and efficacy of lidocaine 1% as a feticidal agent prior to second trimester termination of pregnancy.
  
  
  METHODS
  We conducted a chart review of all patients who underwent a second trimester termination of pregnancy at our institution between March 2009 and June 2012. We collected data regarding the indication for the termination procedure, gestational age, site of lidocaine injection, dosage of lidocaine, need for additional to produce asystole, and maternal complications.
  
  
  RESULTS
  We identified 54 patients who underwent second trimester termination following injection with lidocaine. Forty-six cases (85%) were done for major fetal anomalies and 8 cases (15%) were for maternal indications. The mean gestational age was 22 weeks (SD = 2.3). The mean volume of lidocaine 1% injected was 10.1 mL (range: 5-40 mL). Asystole was achieved in 1-2 minutes following intracardiac administration. Intracardiac injection was successful in 45/46 (98%) of cases. Intrathoracic administration was successful in 5/6 (83%). This approach was chosen when cardiac puncture was not effective. Two fetuses receiving an initial intraabdominal or umbilical vein injection required additional doses of intracardiac lidocaine to produce asystole. There were no maternal complications.
  
  
  CONCLUSIONS
  Intracardiac administration of lidocaine is an effective method to induce cardiac asystole for second trimester pregnancy termination. Extra-cardiac injection, however, is less effective.
authors.affiliation: University of Puerto Rico, Medical Sciences Campus, School of Medicine, Department of Obstetrics and Gynecology, PO Box 365067, San Juan Puerto Rico 00936-5067. ronald.lopez-cepero@upr.edu
authors.forename: Ronald
authors.initials: R
authors.lastname: López-Cepero
authors.forename: Lauren
authors.initials: L
authors.lastname: Lynch
authors.forename: Alberto
authors.initials: A
authors.lastname: de la Vega
mesh_terms: D000028:Abortion, Induced / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced*; D006801:Humans; D008012:Lidocaine / Q000009:adverse effects / Q000627:therapeutic use*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies
chemical_list: D008012:Lidocaine