Intra-amniotic digoxin for feticide between 21 and 30 weeks of gestation: a prospective study

Area of Science:

• Maternal-Fetal Medicine
• Pharmacology
• Reproductive Health

Background:

• Intra-amniotic digoxin is a standard feticide method for termination of pregnancy (TOP) up to 24 weeks gestation.
• Limited data exists on its efficacy and safety beyond 24 weeks gestation.

Purpose of the Study:

• To evaluate the efficacy of intra-amniotic digoxin for inducing fetal demise within 18-24 hours.
• To assess the safety of intra-amniotic digoxin in singleton pregnancies between 21-30 weeks gestation undergoing TOP.
• To determine fetal cardiac activity arrest rates and maternal safety parameters.

Main Methods:

• Prospective cohort study at a tertiary university medical center.
• Inclusion of women at 21-30 weeks gestation undergoing TOP for singleton pregnancies.
• Intra-amniotic injection of 2 mg digoxin followed by ultrasound evaluation for fetal cardiac activity for 18-24 hours.
• Monitoring of maternal serum digoxin levels and electrocardiograms (ECGs).

Main Results:

• Successful fetal demise was achieved in 55 out of 59 cases (93.2%).
• Maternal ECGs remained normal in all participants.
• Mean serum digoxin levels were within the therapeutic range and below toxic levels.
• No cases of extramural delivery or chorioamnionitis were reported.

Conclusions:

• Intra-amniotic digoxin is an effective feticide method for singleton pregnancies between 21-30 weeks gestation.
• The procedure demonstrates a favorable safety profile for mothers undergoing TOP at advanced gestational ages.
• Digoxin injection is a safe and effective option for feticide prior to medical TOP in later pregnancy.