digoxin and Fetal-Death

Standardized treatment of fetal tachyarrhythmia has not been established.. This study sought to evaluate the safety and efficacy of protocol-defined transplacental treatment for fetal supraventricular tachycardia (SVT) and atrial flutter (AFL).. In this multicenter, single-arm trial, protocol-defined transplacental treatment using digoxin, sotalol, and flecainide was performed for singleton pregnancies from 22 to <37 weeks of gestation with sustained fetal SVT or AFL ≥180 beats/min. The primary endpoint was resolution of fetal tachyarrhythmia. Secondary endpoints were fetal death, pre-term birth, and neonatal arrhythmia. Adverse events (AEs) were also assessed.. A total of 50 patients were enrolled at 15 institutions in Japan from 2010 to 2017; short ventriculoatrial (VA) SVT (n = 17), long VA SVT (n = 4), and AFL (n = 29). One patient with AFL was excluded because of withdrawal of consent. Fetal tachyarrhythmia resolved in 89.8% (44 of 49) of cases overall and in 75.0% (3 of 4) of cases of fetal hydrops. Pre-term births occurred in 20.4% (10 of 49) of patients. Maternal AEs were observed in 78.0% (39 of 50) of patients. Serious AEs occurred in 1 mother and 4 fetuses, thus resulting in discontinuation of protocol treatment in 4 patients. Two fetal deaths occurred, mainly caused by heart failure. Neonatal tachyarrhythmia was observed in 31.9% (15 of 47) of neonates within 2 weeks after birth.. Protocol-defined transplacental treatment for fetal SVT and AFL was effective and tolerable in 90% of patients. However, it should be kept in mind that serious AEs may take place in fetuses and that tachyarrhythmias may recur within the first 2 weeks after birth.

Topics: Administration, Oral; Adult; Anti-Arrhythmia Agents; Atrial Flutter; Cesarean Section; Digoxin; Female; Fetal Death; Fetal Diseases; Flecainide; Humans; Infant, Newborn; Injections, Intravenous; Japan; Natriuretic Peptide, Brain; Pregnancy; Pregnancy Complications; Premature Birth; Prenatal Care; Recurrence; Sotalol; Tachycardia; Tachycardia, Supraventricular; Umbilical Veins; Young Adult

To investigate the effect of induced fetal demise on the induction to expulsion interval during later trimester medication abortion.. This retrospective cohort was conducted at St. Paul's Hospital Millennium Medical College, Ethiopia. Later medication abortion cases that had induced fetal demise were compared to matching cases with no induced fetal demise. Data were collected by reviewing maternal charts and analyzed using SPSS version 23. Simple descriptive analysis, χ. A total of 208 patient charts were analyzed. Seventy-nine patients were provided with intra-amniotic digoxin, 37 patients were provided with intracardiac lidocaine, and 92 had no induced demise. The mean induction to expulsion interval was 17.8 hours in the intra-amniotic digoxin group, which is not statistically different than 19.3 hours in the intracardiac lidocaine and 18.5 hours in the group without induced fetal demise (p-value = 0.61). Expulsion rate after 24 hours was not statistically different among the three groups (5.1% in the digoxin group vs 10.6% intracardiac lidocaine group vs 7.8% in the no induced fetal demise group, p-value = 0.82). Multivariate regression analysis demonstrated that inducing fetal demise was not associated with successful expulsion at<24 hours (adjusted odds ratio [AOR] = 0.19, 95% CI, 0.03-1.29 and AOR = 0.62, 95% CI, 0.11-3.48, for digoxin and lidocaine, respectively) from induction.. In this study, inducing fetal demise using digoxin or lidocaine prior to later medication abortion was not associated with a reduction in the induction to expulsion interval.. During later medication abortion with mifepristone and misoprostol, inducing fetal demise may not be associated with a change in the length of the procedure. Induced fetal demise may be required for other reasons.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Digoxin; Female; Fetal Death; Humans; Lidocaine; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, Second; Retrospective Studies

Different foeticide techniques and pharmacological agents have been used to achieve foetal asystole. This study aimed to compare the success of intraamniotic digoxin, intracardiac potassium chloride (KCl), and funic KCl in achieving foetal asystole and discuss procedural difficulties for physicians and clinical outcomes. This prospective observational study included 124 patients who received foeticide at 22-31 weeks of gestation. All procedures were performed transabdominally, and 1 mg of intraamniotic digoxin, funic KCl, or intracardiac KCl was administered. Procedure times, procedural difficulty scores, patient pain scores, decrease in haematocrit levels, induction and hospitalisation times, and the presence of chorioamnionitis were recorded. The foeticide success rates were 93.0, 95.1, and 97.5% for intraamniotic digoxin, intracardiac KCl, and funic KCl, respectively. Intraamniotic digoxin was associated with shorter procedure times, lower procedural difficulty scores, and lower patient pain scores (

Topics: Abortion, Induced; Chorioamnionitis; Digoxin; Female; Fetal Death; Fetal Heart; Heart Arrest; Humans; Potassium Chloride; Pregnancy; Prospective Studies

Transient fetal survival is one issue that providers may face while managing late second-trimester abortion. Induction of fetal demise using digoxin and other means has been widely performed by maternal-fetal medicine and family planning subspecialists worldwide. However, there are no data available in Ethiopia as regards preventing transient fetal survival in late second-trimester medical termination of pregnancy.. The objective of the study was to document the feasibility of intra-amniotic digoxin administration for inducing fetal demise prior to medical abortion beyond 20 weeks of gestational age. Additionally, we aimed to demonstrate that this skill could be transferred to obstetrics and gynaecology residents at St Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia.. A retrospective cross-sectional study design was conducted to document the feasibility, safety and effectiveness of intra-amniotic digoxin. A structured questionnaire was used to collect selected sociodemographic data and clinical characteristics. Data were entered and analysed using SPSS statistical package version 20.. During the study period, 49 women received intra-amniotic digoxin. The success rate of intra-amniotic digoxin in this study was 95.9%. Thirty-seven (75.5%) procedures were performed by obstetrics and gynaecology residents and 12 (24.5%) were performed by family planning faculties. There were two out of hospital expulsions with no signs of life, and no other serious maternal complications were observed.. It is feasible for obstetrics and gynaecology trainees in Ethiopia to learn how to safely administer intra-amniotic digoxin to induce fetal demise for induced medical terminations.

Topics: Abortion, Induced; Adolescent; Adult; Amniotic Fluid; Digoxin; Ethiopia; Feasibility Studies; Female; Fetal Death; Fetus; Humans; Pregnancy

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.. 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.

Topics: Abortion, Induced; Adult; Amnion; Anti-Arrhythmia Agents; Digoxin; Female; Fetal Death; Humans; Injections; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Prospective Studies

We sought to qualitatively understand patients' experiences with digoxin as a step before dilation and evacuation (D&E).. We recruited English-speaking women from one abortion health center where digoxin is routinely used before D&E. We interviewed participants one to three weeks after the D&E about physical and emotional experiences with digoxin and understanding of its purpose. Using grounded theory, we analyzed transcripts iteratively, identifying themes from interviews; we stopped recruitment when we reached thematic saturation.. We conducted 20 interviews and participants described mixed experiences. Three overarching themes from the qualitative interviews were: (1) physical and emotional discomfort; (2) varied understanding of digoxin's purpose and effects; and (3) reassurance. Most participants described significantly negative experiences with digoxin; however, many participants also described positive aspects of the injection intermingled with those negative experiences.. Participants' experiences with digoxin before D&E were both polarized and nuanced. While participants were largely clear about digoxin's action, they were much less clear about the reason for its use.. Both the clinical purpose for and patients' experiences with digoxin before D&E are complicated. Providers who continue to use digoxin should consider patient preferences in how they offer digoxin, and consider tools to ensure patient understanding.

Topics: Abortion, Induced; Adult; Digoxin; Dilatation and Curettage; Emotions; Female; Fetal Death; Humans; Informed Consent; Injections; Pain; Patient Preference; Pregnancy; Young Adult

Several retrospective or single-centre studies demonstrated the efficacy of transplacental treatment of fetal tachyarrhythmias. Our retrospective nationwide survey showed that the fetal therapy will be successful at an overall rate of 90%. For fetuses with hydrops, the treatment success rate will be 80%. However, standard protocol has not been established. The objective of this study is to evaluate the efficacy and safety of the protocol-defined transplacental treatment of fetal tachyarrhythmias. Participant recruitment began in October 2010.. The current study is a multicentre, single-arm interventional study. A total of 50 fetuses will be enrolled from 15 Japanese institutions. The protocol-defined transplacental treatment is performed for singletons with sustained fetal tachyarrhythmia ≥180 bpm, with a diagnosis of supraventricular tachycardia or atrial flutter. Digoxin, sotalol, flecainide or a combination is used for transplacental treatment. The primary endpoint is disappearance of fetal tachyarrhythmias. The secondary endpoints are fetal death related to tachyarrhythmia, proportion of preterm birth, rate of caesarean section attributable to fetal arrhythmia, improvement in fetal hydrops, neonatal arrhythmia, neonatal central nervous system disorders and neonatal survival. Maternal, fetal and neonatal adverse events are evaluated at 1 month after birth. Growth and development are also evaluated at 18 and 36 months of corrected age.. The Institutional Review Board of the National Cerebral and Cardiovascular Center of Japan has approved this study. Our findings will be widely disseminated through conference presentations and peer-reviewed publications.. UMIN Clinical Trials Registry UMIN000004270.

Topics: Anti-Arrhythmia Agents; Atrial Flutter; Child Development; Child, Preschool; Digoxin; Drug Therapy, Combination; Echocardiography, Doppler; Female; Fetal Death; Fetal Diseases; Flecainide; Follow-Up Studies; Humans; Infant; Infant, Newborn; Japan; Male; Pregnancy; Prenatal Care; Prospective Studies; Research Design; Sotalol; Tachycardia, Supraventricular

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.

Topics: Abortion, Induced; Adult; Amniotic Fluid; Confidence Intervals; Digoxin; Dilatation and Curettage; Female; Fetal Death; Gestational Age; Humans; Patient Preference; Pregnancy; Pregnancy Trimester, Second; Prospective Studies; Vagina; Young Adult

Induced abortion via dilation and evacuation (D&E) typically involves cervical preparation. Some clinicians also induce fetal death in the second trimester. We designed this study to determine if the combination of intra-amniotic digoxin and osmotic dilators induced intrauterine inflammatory changes.. Twenty-two women requesting abortion at 19-23 weeks gestation had amniotic fluid sent for measurement of interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α), white blood cell (WBC) count and anaerobic and aerobic cultures on day 1, before dilators and digoxin amnioinjection. Sampling was repeated on Day 2, prior to D&E.. All subjects had significantly elevated IL-6, IL-8 and TNF-α in the amniotic fluid on Day 2. The median difference for IL-6 was 19,893.4 pg/mL (p<.0001), 7040.7 pg/mL (p<.0001) for IL-8 and 181.0 pg/mL (p<.0001) for TNF-α. There was no significant difference in WBC count. There were no clinically significant positive cultures and no clinical infections.. The administration of intra-amniotic digoxin and the placement of osmotic dilators prior to D&E create an intrauterine inflammatory response.

Topics: Abortion, Induced; Adult; Amniocentesis; Amniotic Fluid; Anti-Arrhythmia Agents; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Chorioamnionitis; Digoxin; Dilatation and Curettage; Doxycycline; Female; Fetal Death; Humans; Interleukin-1; Interleukin-8; Leukocyte Count; Pilot Projects; Pregnancy; Pregnancy Trimester, Second; Statistics, Nonparametric; Tumor Necrosis Factor-alpha

Fetal supraventricular tachycardia (SVT) and atrial flutter (AF) can be associated with significant morbidity and mortality. Digoxin is often used as first-line therapy but can be ineffective and is poorly transferred to the fetus in the presence of fetal hydrops. As an alternative to digoxin monotherapy, we have been using sotalol at presentation in fetuses with SVT or AF with, or at risk of, developing hydrops to attempt to achieve more rapid control of the arrhythmia. The present study was a retrospective review of the clinical, echocardiographic, and electrocardiographic data from all pregnancies with fetal tachycardia diagnosed and managed at a single center from 2004 to 2008. Of 29 affected pregnancies, 21 (16 SVT and 5 AF) were treated with sotalol at presentation, with or without concurrent administration of digoxin. Of the 21, 11 (6 SVT and 5 AF) had resolution of the tachycardia within 5 days (median 1). Six others showed some response (less frequent tachycardia, rate slowing, resolution of hydrops) without complete conversion. In 1 fetus with a slow response, the mother chose pregnancy termination. The 5 survivors with a slow response were all difficult to treat postnatally, including 1 requiring radiofrequency ablation as a neonate. One fetus developed blocked atrial extrasystoles after 1 dose of sotalol and was prematurely delivered for fetal bradycardia. Three grossly hydropic fetuses with SVT showed no response and died within 1 to 3 days of treatment. In conclusion, transplacental sotalol, alone or combined with digoxin, is effective for the treatment of fetal SVT and AF, with an 85% complete or partial response rate in our series.

Topics: Abortion, Induced; Anti-Arrhythmia Agents; Atrial Flutter; Bradycardia; Catheter Ablation; Digoxin; Drug Therapy, Combination; Electrocardiography; Female; Fetal Death; Fetal Diseases; Humans; Hydrops Fetalis; Infant, Newborn; Live Birth; Pregnancy; Premature Birth; Retrospective Studies; Sotalol; Tachycardia, Supraventricular

The study was conducted to assess the effectiveness in inducing fetal demise through digoxin injection given 1 day prior to second-trimester pregnancy termination and to evaluate related maternal safety.. A retrospective cohort analysis of 1795 pregnant women between 17 and 24 weeks' gestation who received varying doses of digoxin by transabdominal intrafetal or intra-amniotic injection at the time of laminaria placement was conducted. Fetal heart activity documented by M-mode Doppler sonography on the subsequent day was considered failure. Digoxin dosages started at 1.0 mg for intrafetal and 0.5 mg for intra-amniotic injections and were progressively decreased based on best clinical judgment.. The overall rate of failure to achieve fetal demise was 6.6% (95% CI, 5.5-7.9). Failure rates varied according to route of administration and dosage. There were no failures using a 1.0-mg intrafetal dose, but failures occurred with lower doses. Failure rates were higher with 0.5 mg for intra-amniotic (8.3%) than intrafetal administration (3.6%). There were no adverse maternal events at any of the doses in this study.. Intrafetal digoxin injection at a dose of 1.0 mg is safe and effective for fetal demise prior to pregnancy termination in the second trimester. Significantly lower doses are effective in most cases. Additional doses merit further testing.

Topics: Abortion, Induced; Adolescent; Adult; Cohort Studies; Digoxin; Enzyme Inhibitors; Female; Fetal Death; Fetal Heart; Humans; Injections; Pregnancy; Pregnancy Trimester, Second; Retrospective Studies; Ultrasonography, Prenatal

Hydrops fetalis thought to be due to Ebstein's anomaly was seen at 22 weeks' gestation in one of two fetuses with a monochorionic placenta. Hydrops was treated with maternal digitalization and resolved by the 28th week of gestation. Hydrops did not recur while maternal digitalization continued. A clinical diagnosis of twin-to-twin transfusion syndrome required termination of the pregnancy at 33 weeks of gestation. The twin with Ebstein's anomaly died 22 hours after birth. The other twin survived and was normal at 19 months of age. Thus, administration of digitalis to the mother controlled hydrops fetalis in one fetus, and ultimately led to the survival of the healthy infant.

Topics: Adult; Amniotic Fluid; Digoxin; Diseases in Twins; Ebstein Anomaly; Female; Fetal Death; Humans; Hydrops Fetalis; Pregnancy

Topics: Anti-Arrhythmia Agents; Digoxin; Drug Therapy, Combination; Electrocardiography; Female; Fetal Death; Fetal Diseases; Flecainide; Gestational Age; Heart Failure; Humans; Hydrops Fetalis; Infant, Newborn; Pregnancy; Tachycardia, Supraventricular; Ultrasonography, Prenatal

The supraventricular tachycardia is a life threatening state in the intrauterine life. It can cause non-immune hydrops fetalis, intrauterine death or complications during the delivery. The unexplained tachycardia can cause fetal distress and premature delivery. Usually the digoxin is the first drug of choice for transplacental cardioversion. If digitalisation does not achieve cardioversion, the second line antiarrhythmic drugs should be instituted. Amiodarone has been suggested as a therapeutic alternative after failure of digoxin-verapamil combination. We give a drug in standard therapeutic doses for four-five days and after it we determine whether it is effective or not. We should determine the newer therapy or termination of pregnancy. The transplacental administration of amiodarone may be dangerous because of fetal cretinism. Our case is the first in Hungary-in our best knowledge- and we suggest the amiodarone for transplacental therapy.

Topics: Adult; Amiodarone; Anti-Arrhythmia Agents; Digoxin; Drug Therapy, Combination; Female; Fetal Death; Fetal Diseases; Humans; Hungary; Pregnancy; Tachycardia, Supraventricular; Ultrasonography, Prenatal

Adenosine terminates supraventricular reentry tachycardia safely and effectively in the pediatric age group.. The recurrence of pretreated incessant tachycardia led to severe hydrops in a 28-week-old fetus. The tachycardia was terminated instantly with direct fetal administration of adenosine via the umbilical vein. Normal heart rate and rhythm were then preserved temporarily with digoxin and flecainide.. Direct fetal adenosine administration might be helpful in the treatment of fetal reentry tachycardias if the sinus rhythm achieved quickly can be preserved by long-acting antiarrhythmic drugs. Such a combined therapeutic approach might be especially advantageous in hydropic fetuses.

Topics: Adenosine; Digoxin; Female; Fetal Death; Flecainide; Gestational Age; Heart Rate; Humans; Hydrops Fetalis; Injections, Intravenous; Pregnancy; Recurrence; Tachycardia, Supraventricular; Ultrasonography; Umbilical Veins

To determine the safety of providing outpatient abortion services for women with complicated advanced pregnancies.. During a 10-year period, 124 abortions were performed after 14 menstrual weeks' gestation at an outpatient abortion facility for indications of fetal anomaly, diagnosed genetic disorder, or fetal death. Gestational lengths ranged from 15-34 menstrual weeks. Fetal diagnoses included a variety of chromosomal abnormalities, malformations, and death. Techniques for performing the late abortions included a serial multiple laminaria method of cervical dilation. Abortions performed after 20 menstrual weeks were effected by instillation of intra-amniotic hyperosmolar urea or induction of fetal death by injection of digoxin and/or hyperosmolar urea into the fetus, followed by artificial rupture of membranes, induction of labor, and assisted expulsion or instrumental extraction of the fetus. At less than 20 weeks, dilation and evacuation following serial multiple laminaria treatment of the cervix was the method of choice.. The median gestational age was 23 menstrual weeks. The median procedure time for all cases was 12 minutes and median blood loss was 125 mL. Procedure time increased with length of gestation (P = .00). Blood loss was only slightly increased by gestation length (P = .154) and not by procedure time (P = .299). Complication rates were not significantly related to gestation length (P = .895). There was one major complication in this series. There were no uterine perforations and one cervical laceration.. Outpatient abortion may be performed safely in most cases of fetal disorder, including death, through 34 menstrual weeks under proper conditions.

Topics: Abortion, Eugenic; Abortion, Induced; Adult; Ambulatory Care; Ambulatory Care Facilities; Anesthesia, Obstetrical; Congenital Abnormalities; Digoxin; Extraction, Obstetrical; Female; Fetal Death; Humans; Labor, Induced; Laminaria; Pregnancy; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Urea

Fourteen mothers were treated with flecainide for fetal atrial tachycardias associated with intrauterine cardiac failure. Twelve of the 14 fetuses responded by conversion to sinus rhythm. One of the 12 fetuses subsequently died in utero. The remaining fetuses suffered no morbidity and were alive and well 3 months to 2 years after delivery. The two fetuses in whom atrial tachycardia did not convert with flecainide were successfully treated with digoxin. These results compare favourably with previous forms of antiarrhythmic treatment. After recent reports of the side effects of flecainide treatment, however, it has been advised that this drug should be confined to high risk patients and those with life threatening arrhythmias. The use of flecainide for fetal arrhythmias should be limited to patients with severe fetal hydrops and supraventricular tachycardias. It should not be the first drug of choice in atrial flutter.

Topics: Cardiac Output, Low; Digoxin; Female; Fetal Death; Fetal Diseases; Flecainide; Humans; Pregnancy; Tachycardia

A case of nonimmune hydrops fetalis associated with a supraventricular tachycardia was successfully treated with digoxin and verapamil. After resolution of the hydropic changes, however, the fetus unexplainedly died. Side effects from the drug therapy may have been responsible for the event.

Topics: Adult; Digoxin; Drug Therapy, Combination; Female; Fetal Death; Fetal Diseases; Humans; Pregnancy; Tachycardia, Supraventricular; Verapamil

Topics: Adult; Chlorpropamide; Digoxin; Female; Fetal Death; Furosemide; Gestational Age; Heart Valve Prosthesis; Humans; Mitral Valve Stenosis; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy in Diabetics; Warfarin