The effect of induced fetal demise on induction to expulsion interval during later medication abortion: A retrospective cohort

Abstract

Objectives: To investigate the effect of induced fetal demise on the induction to expulsion interval during later trimester medication abortion.

Study design: This retrospective cohort was conducted at St. Paul's Hospital Millennium Medical College, Ethiopia. Later medication abortion cases that had induced fetal demise were compared to matching cases with no induced fetal demise. Data were collected by reviewing maternal charts and analyzed using SPSS version 23. Simple descriptive analysis, χ² test, and multiple logistic regression analysis were used as appropriate. Odds ratio, 95% CI, and p-value<0.05 were used to present the significance of the findings.

Results: A total of 208 patient charts were analyzed. Seventy-nine patients were provided with intra-amniotic digoxin, 37 patients were provided with intracardiac lidocaine, and 92 had no induced demise. The mean induction to expulsion interval was 17.8 hours in the intra-amniotic digoxin group, which is not statistically different than 19.3 hours in the intracardiac lidocaine and 18.5 hours in the group without induced fetal demise (p-value = 0.61). Expulsion rate after 24 hours was not statistically different among the three groups (5.1% in the digoxin group vs 10.6% intracardiac lidocaine group vs 7.8% in the no induced fetal demise group, p-value = 0.82). Multivariate regression analysis demonstrated that inducing fetal demise was not associated with successful expulsion at<24 hours (adjusted odds ratio [AOR] = 0.19, 95% CI, 0.03-1.29 and AOR = 0.62, 95% CI, 0.11-3.48, for digoxin and lidocaine, respectively) from induction.

Conclusions: In this study, inducing fetal demise using digoxin or lidocaine prior to later medication abortion was not associated with a reduction in the induction to expulsion interval.

Implications: During later medication abortion with mifepristone and misoprostol, inducing fetal demise may not be associated with a change in the length of the procedure. Induced fetal demise may be required for other reasons.

Keywords: Abortion; Digoxin; Induced fetal demise; Induction to abortion interval; Later medication abortion; Lidocaine; Second-trimester abortion.