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The safety and efficacy of digoxin as a feticidal agent prior to 2nd trimester abortion

Gillian Dean, Planned Parenthood of New York City, 2008
See also executive summary and publication in Contraception.

Project abstract

Physicians have used digoxin prior to abortion for many years. In response to the 2007 Supreme Court decision upholding the Partial Birth Abortion Act, use of digoxin became widespread.

Published data on digoxin in abortion are limited. A few studies demonstrate that digoxin is not associated with adverse cardiac events when used in doses of 1mg or less. At these doses and with a variety of injection sites, digoxin is 92% to 93% effective at achieving fetal demise. However, little is known about the risk of adverse events such as chorioamnionitis or miscarriage, and only one study examined efficacy by injection site. Although two large series reported infrequent cases of miscarriage after digoxin, these studies were not designed to report these occurrences reliably; moreover, they do not compare rates of adverse events to dilation and evacuation (D&E) without digoxin.

In response to a revision of Planned Parenthood Federation of America's Medical Standards and Guidelines, Planned Parenthood of New York City initiated use of digoxin before D&E at 18-24 weeks in May, 2007. We propose to conduct a retrospective double cohort record review of approximately 1,000 patients to compare complication rates in patients who received digoxin prior to D&E with complication rates in patients who underwent D&E without digoxin. We will also analyze data from the digoxin cohort to examine the efficacy of digoxin to achieve feticide by gestational age and site of injection. The digoxin cohort will include all patients who received digoxin before D&E at our site from 5/23/07 through 3/31/08. The nondigoxin cohort will be comprised of an equal number of patients who received D&E prior to 5/23/07 matched for gestational age.

The increasing use of digoxin following the Supreme Court decision has created a compelling need for research to assess the safety of this feticidal agent.

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