Induction of fetal demise in advanced pregnancy terminations: report on a funic potassium chloride protocol

Abstract

Advanced pregnancy termination with uterotonic agents with their inherent risk for occurrence of a live birth and surgical evacuation of a fetus perceived to be vigorous can both be sources of emotional anguish for women. They argue for offering women an option for induction of fetal demise prior to uterine evacuation. We report on our experience with 60 pregnancies in which lethal fetal administration of potassium chloride was performed prior to evacuation of the uterus. We describe a double-bolus technique for funic intravascular injection of potassium chloride to arrest the fetal heart. There were no maternal complications and the procedure was successful in 86.7% (n = 52) of the cases; of the remaining 8 cases, 7 had demise induced by direct fetal cardiac injection, and a live birth occurred in 1 case.

PIP: Between May 1988 and December 1992, physicians at the University of Washington Hospital used a double-bolus technique of injecting no more than 10 mEq potassium chloride into the umbilical vein to cause fetal cardiac arrest in 60 pregnant women (=or 19 weeks gestation; 28 weeks in 4 cases). They induced fetal death prior to uterine evacuation to limit emotional anguish in these women. Congenital anomalies, teratogen exposure, or early obstetric complications were indications for these abortions. 52 women (86.7%) suffered no complications and experienced a successful lethal administration of potassium chloride. 7 cases required direct fetal cardiac injection of 6 mEq potassium chloride due to either inability to gain funic vascular access or irregular slow ventricular activity with subsequent complete recovery of ventricular function. In the 8th case, the gestation was 24 weeks. Severe oligohydramnios secondary to the premature rupture of chorioamnion complicated the case. After funic placement was lost, the 8th case denied further intervention. She delivered a live infant the following day, but the infant died. Upon death of the fetuses, uterine evacuation was accomplished by medical evacuation (i.e., vaginal prostaglandin suppositories and oxytocin infusion) or surgical evacuation. The clinicians noted that lethal fetal administration of potassium chloride in advanced pregnancy termination limits the involvement of medical staff in ethically sensitive issues. The findings show that this methodology is safe for the woman and effective at preventing live births.