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

Authors

Abraham Fessehaye Sium, Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia.
Kidist Lemma, Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia.
Zerihun Beyene, Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia.
Lemi Belay Tolu, Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia.
Demsash Hailu, Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia.
Matthew F. Reeves, DuPont Clinic, Washington, DC, USA.
Sarah Prager, Division of Complex Family Planning, Department of Obstetrics and Gynecology, UW Medicine, Seattle, WA, USA.

Document Type

Journal Article

Publication Date

4-11-2025

Journal

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

DOI

10.1002/ijgo.70158

Keywords

digoxin; fetal cardiac asystole; fetal demise; feticide; lidocaine; 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 χ 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).

APA Citation

Sium, Abraham Fessehaye; Lemma, Kidist; Beyene, Zerihun; Tolu, Lemi Belay; Hailu, Demsash; Reeves, Matthew F.; and Prager, Sarah, "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" (2025). GW Authored Works. Paper 7068.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7068

Department

Obstetrics and Gynecology