Inducing fetal demise in a low-middle income country: A prospective cohort of intracardiac lidocaine versus intra-amniotic digoxin for inducing fetal demise before second-trimester medication abortion

Abstract

Objective: To compare the effectiveness of lidocaine versus digoxin for inducing fetal cardiac asystole before medication abortion at 20-28 weeks of pregnancy.

Methods: This was a prospective cohort study among women who underwent a medication abortion at 20-28 weeks of pregnancy using either intra-amniotic digoxin or intracardiac lidocaine for inducing fetal asystole. The study was conducted at St. Paul's Hospital over 1 year, April 2023 to March 2024. Data were collected prospectively using a structured questionnaire. Data analysis was carried out using χ² test and Fisher exact test as appropriate.

Results: We included 151 women (101 who had an intra-amniotic digoxin injection and 50 who had a fetal intracardiac lidocaine injection) in the final analysis. We found no difference in the mean induction to expulsion time between the groups (9.5 h in intra-amniotic group versus 11.9 h in the intracardiac lidocaine group, P = 0.06). The interval from administration of the feticidal agent to fetal asystole was longer in the digoxin group compared with the lidocaine group (25.1 vs. 0.7 h, P < 0.001). We identified two cases in the digoxin group that required a second dose of digoxin, for an effectiveness rate of 98% (99/101) versus an effectiveness of 100% in the lidocaine group. Fetal asystole was achieved within 5 h in all cases with lidocaine.

Conclusion: In this study, intracardiac lidocaine and intra-amniotic digoxin were found to have comparable effectiveness at inducing fetal asystole and comparable length of medication abortion (induction to expulsion interval).

Keywords: digoxin; fetal cardiac asystole; fetal demise; feticide; lidocaine; medication abortion.