Intra-fetal Compared With Intra-amniotic Digoxin Before Dilation and Evacuation: A Randomized Controlled Trial

Area of Science:

• Medical Science
• Obstetrics and Gynecology
• Pharmacology

Background:

• Second-trimester surgical pregnancy termination often requires inducing fetal asystole.
• Digoxin is used to achieve fetal asystole, but its optimal administration route is debated.

Purpose of the Study:

• To compare the effectiveness of 1.0 mg intra-fetal versus intra-amniotic digoxin for achieving fetal asystole prior to surgical pregnancy termination.

Main Methods:

• A randomized trial involving 270 women between 20-24 weeks gestation.
• Participants received either intra-fetal or intra-amniotic digoxin (1.0 mg) before dilation and evacuation.
• Primary outcome was the incidence of fetal asystole documented before the procedure.

Main Results:

• Intra-fetal digoxin resulted in a higher proportion of fetal asystole (94.8%) compared to intra-amniotic digoxin (82.3%).
• The relative risk of failure to achieve asystole was significantly higher with the intra-amniotic route.
• No significant differences were observed in adverse events or procedural parameters between the groups.

Conclusions:

• Intra-fetal administration of digoxin is a more effective method for achieving fetal asystole before second-trimester surgical pregnancy termination.
• The findings support intra-fetal digoxin as a preferred route for this indication.