In response to the federal abortion ban of 2003, an increasing number of providers are using feticidal agents prior to late second trimester terminations (353). Intra-amniotic or intrafetal digoxin and intracardiac potassium chloride are the two most common agents used for this purpose. Both are efficacious with little maternal adverse effects (354,355). The clinical utility of these agents is unproven. The only randomized controlled study looking at clinical outcomes found no change in procedure time or blood loss with the use of digoxin (356). Varying doses of digoxin were reported. In one study, 1.5 mg intra-amniotic digoxin was always successful in inducing fetal demise within 24 hours (357).
Labor-Induction Methods In Europe and the United Kingdom labor induction is much more common than D&E for midtrimester abortion (358). Induction abortion with hypertonic saline or urea was widely employed for labor induction abortion in the 1970s. These were supplanted by the use of synthetic prostaglandins, and by regimens that combine mifepristone and misoprostol.
Prostaglandins Prostaglandins of the E and F series can cause uterine contraction at any stage of gestation. The 15 methyl analogues of prostaglandin F2α (carboprost) and prostaglandin E2 (dinoprostone) are highly effective for midtrimester abortion but frequently produce side effects of vomiting, diarrhea, and with dinoprostone, fever. Misoprostol a 15 methyl analogue of PGE1, is much less expensive than other prostaglandins, stable at room temperature, and at doses effective for abortion, produces many fewer side effects (359). Transient fetal survival is not infrequent after prostaglandin inductions. In the United States, it is common to produce fetal demise before induction with regimens similar to those used in late second trimester dilation and evacuation:. intra-amniotic or intrafetal digoxin, 1 to 1.5 mg, or fetal intracardiac potassium chloride (3 mL of a 2-mmol solution).