Effectiveness of 1mg and 2mg Intra Amniotic Digoxin for Fetal Demise in Second-trimester Anomaly: A Cross Sectional Study

Abstract

Introduction: Inducing fetal demise before termination after near viable gestational ages is practiced widely to avoid signs of life at delivery and reduce emotional trauma to the mother and her family. Digoxin is instilled by intra-fetal or intra-amniotic routes at varying doses. In this study, we have used intra-amniotic digoxin and simultaneously compared the effectiveness of two doses of digoxin 1 mg and 2 mg.

Methods: This was a hospital-based Cross Sectional study conducted in the Department of Obstetrics and Gynecology at Pokhara Academy of Health Sciences from 1/1/2021 to 30/6/2021. A total of 24 pregnant women with gestational age sranging from 20 to 28 weeks with fetal anomalies confirmed by ultrasonography were enrolled in the study This time interval is the optimum time to detect fetal anomaly in second trimester. Ultrasound-guided intra-amniotic digoxin as 1 mg and 2 mg were instilled serially. Fetal cardiac activity was checked by ultrasound at 18 hours and 24 hours of digoxin injection.

Results: Among 24 cases of fetal anomaly, the majority occurred in primigravida (n = 14, 58.3%) with a mean age of 24.6 years and mean gestational age of 24.4 weeks. The most common fetal anomaly was hydrocephalus (n = 9, 37.5%) followed by anencephaly (n = 6, 25%). Among 24 cases only one case had persistent fetal cardiac activity after 24 hours of digoxin who was at 28 weeks of gestation and had received 1 mg of digoxin.

Conclusion: Intra-amniotic injection of digoxin 1 mg is as effective as 2 mg at causing fetal demise by 18-24 hours.