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Safety of intra-amniotic and intra-fetal digoxin administration before late 2nd trimester abortion by dilation and evacuation

Eleanor Drey, University of California, San Francisco, 2008

Project abstract

Goal: To determine the safety and pharmacokinetics of intra-amniotic and intra-fetal digoxin injection before late second-trimester pregnancy termination by dilation and evacuation

Objectives: To establish safety and pharmacokinetics of 1.5 mg intra-amniotic and 1 mg intra-fetal digoxin injection before late second-trimester dilation and evacuation (D&E) through an assessment of maternal systemic digoxin absorption, cardiac rhythm, electrolytes, and coagulation parameters.

Background: Clinicians have been using digoxin to facilitate second-trimester pregnancy termination for many years. But since the Partial Birth Abortion Ban in 2007, there has been an increased use of feticidal techniques for fear that the law may be interpreted as applying to most D&Es. Many clinicians have changed their practices to include digoxin in varying doses and routes.

Methods: Pregnant women at 19 to 23 weeks gestation will receive either 1.5 mg intra-amniotic or 1 mg intra-fetal digoxin by intrauterine injection. Patients will then have Holter cardiac monitoring for 24 hours. Clotting parameters will be assessed before digoxin administration and at the time of the dilation and evacuation procedure. As part of the pharmacokinetic safety study, we also will monitor electrolytes, blood count, and serum digoxin levels for 48 hours.

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