Patient acceptability of intra-amniotic digoxin versus intracardiac lidocaine for inducing foetal demise prior to second trimester medical abortion: a prospective cohort

Abstract

Objective: To compare patient acceptability of inducing foetal demise procedures between intracardiac lidocaine and intra-amniotic digoxin administration prior to second trimester medical abortion.

Methods: We enrolled a prospective cohort of women who received either intra-cardiac lidocaine or intra-amniotic digoxin during second trimester medical abortion at later gestation (20-28 weeks) at our centre between April 2023 and March 2024. Data were collected prospectively using a structured questionnaire. For data analysis, Chi-squared test and Fisher's exact test were performed as appropriate. P-value less than 0.05 was used to present results significance.

Results: A total of 151 women (101 who had intra-amniotic digoxin injection and 50 women who had foetal intracardiac lidocaine injection) were analysed. The groups had similar mean gestational age (22.42 weeks vs 22.65 weeks, in the digoxin vs lidocaine groups respectively, p-value = 0.50). More women from the digoxin group described the pain associated with foeticide administration as 'as expected' than in the intra-cardiac lidocaine group (48% vs 30%, p-value = 0.005). Similarly, more women in the digoxin group described their overall experience of foeticide administration as 'not bad' compared to those who received intra-cardiac lidocaine (59.4% vs 32%, p-value = 0.006). Likewise, more women in the digoxin group stated they would recommend the same procedure for friends or family members should they face the same problem than in the lidocaine group (43% vs 14%, p-value = 0.001).

Conclusions: Our study shows that intra-amniotic digoxin has superior patient acceptability than intracardiac lidocaine by women undergoing safe second trimester medical abortion at later gestion.

Keywords: Digoxin; foetal cardiac asystole; foetal demise; foeticide; lidocaine; medical abortion.