Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.
Sackler School of Medicine, Tel Aviv University, Israel.
BJOG. 2019 Jun;126(7):885-889. doi: 10.1111/1471-0528.15640. Epub 2019 Mar 12.
Intra-amniotic injection of digoxin is a well-known method for feticide before inducing a termination of pregnancy (TOP) at 17-24 weeks of gestation. Information on its effectiveness when administered after 24 weeks of gestation is limited. This study evaluated the efficacy of intra-amniotic digoxin injection for inducing fetal demise within 18-24 hours, at 21-30 weeks of gestation, and its safety.
Prospective cohort study.
Tertiary university medical centre.
Women at 21-30 weeks of gestation with a singleton pregnancy, admitted for TOP.
Intra-amniotic injection of 2 mg of digoxin was performed 1 day before medical TOP. Fetal heart activity was evaluated by ultrasound for 18-24 hours after the injection. Serum digoxin level and maternal electrocardiogram (ECG) were evaluated 6, 10, and 20 hours after injection.
Frequency of successful fetal demise.
Fifty-nine women participated in the study. The mean gestational age was 24 weeks (range 21 -30 ), with 29 (49.2%) beyond 24 weeks of gestation. Fetal cardiac activity arrest was achieved in 55/59 cases (93.2%). Normal maternal ECG recordings were noted in all cases. Mean serum digoxin levels 6 and 10 hours after injection were in the therapeutic range (1.3 ± 0.7 ng/l and 1.24 ± 0.49 ng/l, respectively) and below the toxic level (2 ng/l). Extramural delivery following digoxin did not occur. There were no cases of chorioamnionitis.
Intra-amniotic digoxin for feticide at 21-30 weeks of gestation in a singleton pregnancy appears effective and safe before TOP at advanced gestational ages.
This study shows that feticide by intra-amniotic digoxin injection at 21-30 weeks of gestation appears effective and safe.
在妊娠 17-24 周时，羊膜腔内注射地高辛是一种众所周知的终止妊娠（TOP）前杀胎方法。关于妊娠 24 周后使用地高辛的有效性的信息有限。本研究评估了在 21-30 孕周、单胎妊娠的情况下，羊膜腔内注射地高辛在 18-24 小时内诱导胎儿死亡的效果及其安全性。
前瞻性队列研究。
三级大学医学中心。
妊娠 21-30 周、单胎妊娠、因 TOP 入院的孕妇。
在医学 TOP 前 1 天进行羊膜腔内注射 2 毫克地高辛。注射后 18-24 小时通过超声评估胎儿心脏活动。注射后 6、10 和 20 小时评估血清地高辛水平和母体心电图（ECG）。
成功胎儿死亡的频率。
59 名妇女参与了这项研究。平均孕周为 24 周（范围 21-30 周），29 例（49.2%）超过 24 周。55/59 例（93.2%）胎儿心脏活动停止。所有病例均记录到正常的母体心电图。注射后 6 小时和 10 小时的平均血清地高辛水平分别在治疗范围内（分别为 1.3±0.7ng/l 和 1.24±0.49ng/l），低于中毒水平（2ng/l）。地高辛注射后没有发生宫外分娩。无一例绒毛膜羊膜炎。
在妊娠晚期，羊膜腔内注射地高辛在妊娠 21-30 周、单胎妊娠的情况下，在晚期妊娠进行 TOP 前似乎是有效且安全的。
本研究表明，在妊娠 21-30 周、单胎妊娠的情况下，羊膜腔内注射地高辛杀胎似乎是有效且安全的。
