Clinical GuidelinesInduction of fetal demise before abortion
Section snippets
Background
Induced abortion is the second most common surgery for reproductive-aged women in the United States, after cesarean delivery [1], [2]. The safety of this common procedure is well-established [3]. Surgical and medical methods of abortion can be performed safely in the second trimester, and even in the third trimester when pregnancy termination usually is completed by medical induction for lethal fetal anomalies or other significant medical conditions affecting the pregnant woman [4].
During the
Outside of legal concerns, what are the medical reasons providers induce fetal demise before abortion?
The most commonly reported use of feticidal agents is for selective termination and multifetal pregnancy reduction [71]. Since the advent of ovulation stimulation, IVF and GIFT, many women treated for infertility get pregnant with multiple gestations. There have been no randomized controlled trials (RCTs) comparing pregnancy reduction to carrying multiple gestations to delivery with respect to any fetal or maternal outcomes. The reduction of higher-order gestations to twins — or twins to a
Conclusions and recommendations
Based on the highest level of evidence found in the data, recommendations are provided and graded according to the following categories:
Level A: Recommendations are based primarily on good and consistent scientific evidence.
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One milligram of intra-amniotic digoxin is no better than placebo to decrease procedure time or provider-reported technical difficulty. Patients have increased vomiting after intra-amniotic digoxin injections.
Level B: Recommendations are based primarily on limited or
Important questions to be answered
Although we have primarily observational data about the safety and effectiveness of feticidal injections, there is a paucity of the highest level of evidence — RCTs — about the effect of inducing fetal demise on the safety, speed and risks of the abortion procedure itself, before either D&E or induction termination. We currently have inadequate data to recommend this intervention to increase the safety of D&E. In order to study the safety and absorption of digoxin and KCl, we need more
Acknowledgments
The authors would like to thank Erin Cassad Schultz, JD, and Jennifer Templeton Dunn, JD, for their assistance in addressing the medicolegal issues surrounding the use of feticidal agents.
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