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Intrafetal digoxin as an adjuvant for dilation and evacuation at 20 to 24 weeks’ gestation: a placebo-controlled, double-blinded randomized controlled trial

Jennifer Kerns, MD, University of California, San Francisco

Project abstract

Feticide with digoxin before abortion is a common practice in the later second trimester. Some providers who utilize this practice report that it results in a faster and easier dilation and evacuation (D&E). Discomfort with and legal concerns regarding later abortion on a viable fetus also may influence some providers to utilize this practice.

The safety of abortion by D&E in the later second trimester without feticide is well established; however, data from a randomized controlled trial and some observational studies do not support its use. Specifically, the only randomized controlled trial that assessed the effect of intra-amniotic digoxin on D&E provision did not show that digoxin increased D&E speed or improved any other markers of abortion safety. Additionally, feticide is a procedure that inherently carries risks, including vomiting and unscheduled spontaneous deliveries outside of a clinical setting.

We propose a multi-site randomized controlled trial to assess the effect of intrafetal digoxin on D&E duration at 20-24 weeks’ versus saline placebo. We also intend to measure risks, complications and provider and patient acceptability associated with feticide versus placebo. The findings of the study will have implications for whether feticide should be done before D&E at more advanced gestations.

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