The Utility of Feticide Procedure to Shorten the Induction-to-Abortion Interval in Medical Abortion

Abstract

Aim: To evaluate the effect of intracardiac potassium chloride feticide procedure (FP) on the induction-to-abortion (I-to-A) interval for various indications in the termination of pregnancy. Method: Medically indicated abortions between 17 and 28 weeks’ gestation were retrospectively evaluated and allocated into 2 groups: Cases with (group 1, n = 58) or without an FP (group 2, n = 60). I-to-A intervals were compared across the groups, considering different baseline parameters and fetal abnormality categories. Results: There were no differences among the groups except in gestational age (GA; mean, 21.2 vs. 19.6 weeks, p = 0.01) in group 1. Overall, the I-to-A interval was shorter (900 ± 233 vs. 1,198 ± 375 min, p = 0.001) and prolonged medical abortion (I-to-A interval > 48 h) was less common (2% vs. 6%, p = 0.03) in group 1. The facilitating effect of FP persisted when indications were categorized as central nervous system, chromosomal, other structural abnormalities, and unclassified conditions. Logistic regression analyses demonstrated the following features to be associated with expulsion of fetus after 24-h: (1) advanced GA (> 24 week; aOR 6.9, 95% CI 3.24–14.72), (2) central nervous system abnormalities (aOR 5.3, 95% CI 2.6–11.4), (3) lack of feticide (aOR 3.67, 95% CI 2.24–10.72). Conclusion: FPs seem to shorten the I-to-A interval and decrease prolonged I-to-A interval rates. This facilitating effect remains unchanged for various medical indications.

Mifepristone-misoprostol versus misoprostol alone for second trimester termination of pregnancy in a tertiary hospital in Hong Kong

“…It can be a pilot study for future larger-scale studies and prospective studies. Patients at late second trimester (22 weeks to 23 weeks 6 days) were excluded owing to the possible confounding effect of fetocide on the time from induction to abortion 25 . Both vaginal and oral routes were used for misoprostol administration.…”

Feticide Before Termination of Pregnancy in Singleton Pregnancy – Trends in England and Wales 2012-2020, a cross-sectional study

“…Healthcare professionals may also fear legal action being taken against them in these situations [7,8]. Additionally, there is some evidence that feticide is associated with a decreased duration of the TOP procedure [9][10][11].…”

Effectiveness of intra-cardiac lidocaine and intra-amniotic digoxin at inducing fetal demise before second trimester abortion past 20 weeks at a tertiary Hospital in Ethiopia: A retrospective review

“…World Health Organization (WHO) abortion guidelines recommend consideration of fetal demise in medical termination of pregnancy above 20 weeks of gestation [7] . Inducing fetal demise before the second-trimester medication abortion can help circumvent the social, psychological and legal problems that face the team of caregivers, and the client undergoing abortion [ 8 , 9 ]. Moreover, there is an emerging evidence that beyond achieving negative fetal heartbeat, feticide administration before second trimester medication abortion shortens the induction to expulsion interval.…”