%0 Journal Article
%T Intra-amniotic digoxin for feticide between 21 and 30 weeks of gestation: a prospective study.
%A Sharvit M
%A Klein Z
%A Silber M
%A Pomeranz M
%A Agizim R
%A Schonman R
%A Fishman A
%J BJOG
%V 126
%N 7
%D Jun 2019
%M 30703286
%F 7.331
%R 10.1111/1471-0528.15640
%X <B>OBJECTIVE: </B>Intra-amniotic injection of digoxin is a well-known method for feticide before inducing a termination of pregnancy (TOP) at 17-24 weeks of gestation. Information on its effectiveness when administered after 24 weeks of gestation is limited. This study evaluated the efficacy of intra-amniotic digoxin injection for inducing fetal demise within 18-24 hours, at 21-30 weeks of gestation, and its safety.<BR><B>METHODS: </B>Prospective cohort study.<BR><B>METHODS: </B>Tertiary university medical centre.<BR><B>METHODS: </B>Women at 21-30 weeks of gestation with a singleton pregnancy, admitted for TOP.<BR><B>METHODS: </B>Intra-amniotic injection of 2 mg of digoxin was performed 1 day before medical TOP. Fetal heart activity was evaluated by ultrasound for 18-24 hours after the injection. Serum digoxin level and maternal electrocardiogram (ECG) were evaluated 6, 10, and 20 hours after injection.<BR><B>METHODS: </B>Frequency of successful fetal demise.<BR><B>RESULTS: </B>Fifty-nine women participated in the study. The mean gestational age was 24+2  weeks (range 21+0 -30+0 ), with 29 (49.2%) beyond 24+0  weeks of gestation. Fetal cardiac activity arrest was achieved in 55/59 cases (93.2%). Normal maternal ECG recordings were noted in all cases. Mean serum digoxin levels 6 and 10 hours after injection were in the therapeutic range (1.3 ± 0.7 ng/l and 1.24 ± 0.49 ng/l, respectively) and below the toxic level (2 ng/l). Extramural delivery following digoxin did not occur. There were no cases of chorioamnionitis.<BR><B>CONCLUSIONS: </B>Intra-amniotic digoxin for feticide at 21-30 weeks of gestation in a singleton pregnancy appears effective and safe before TOP at advanced gestational ages.<BR><B>CONCLUSIONS: </B>This study shows that feticide by intra-amniotic digoxin injection at 21-30 weeks of gestation appears effective and safe.