Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA.
Contraception. 2013 Jan;87(1):76-80. doi: 10.1016/j.contraception.2012.07.019. Epub 2012 Sep 7.
Transabdominal injection of digoxin into the amniotic fluid or fetus to induce fetal demise before dilation and evacuation (D&E) abortion has become common practice since the passage of the Partial-Birth Abortion Ban Act in 2007.
We performed a prospective study to assess the feasibility of transvaginal administration of intraamniotic digoxin the day before D&E. All women between 18 0/7 and 23 5/7 weeks of gestation seeking termination from December 2009 to May 2011 were approached for study participation. Women who declined participation were asked to identify their primary rationale. For women declining study participation, transection of the umbilical cord during D&E was performed to meet the requirements of the ban.
Over 18 months, 134 women met study entry criteria and 108 (81%) declined to participate. Of the 26 women who enrolled, 1.0 mg undiluted digoxin was successfully administered transvaginally in 24 (92%, 95% confidence interval 75%-99%). The most common reasons for declining participation were discomfort with preoperatively inducing fetal demise (37%) and desire to avoid a medically unnecessary medication (36%).
Transvaginal administration of digoxin is a feasible alternative to transabdominal administration to induce preoperative fetal demise. The majority of women decline digoxin administration when an alternative is available.
自 2007 年《部分分娩堕胎禁令法案》通过以来，在扩张和排空（D&E）堕胎前将地高辛经腹部注入羊膜腔或胎儿中以诱导胎儿死亡的做法已变得很常见。
我们进行了一项前瞻性研究，以评估 D&E 前一天经阴道给予羊膜内地高辛的可行性。所有在 2009 年 12 月至 2011 年 5 月期间寻求终止妊娠且妊娠 18 0/7 至 23 5/7 周的女性均被邀请参加研究。拒绝参加的女性被要求说明其主要理由。对于拒绝参加研究的女性，在 D&E 期间切断脐带以满足禁令的要求。
在 18 个月的时间里，有 134 名女性符合研究纳入标准，其中 108 名（81%）拒绝参与。在 26 名入组的女性中，24 名（92%，95%置信区间 75%-99%）成功经阴道给予了未稀释的 1.0 毫克地高辛。拒绝参与的最常见原因是术前诱导胎儿死亡时感到不适（37%）和希望避免使用不必要的药物（36%）。
经阴道给予地高辛是一种替代经腹部给药以诱导术前胎儿死亡的可行方法。当有替代方案时，大多数女性拒绝给予地高辛。
