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Transabdominal lidocaine to induce fetal demise: a cohort study
  1. Matthew F Reeves1,2,3,4,
  2. Caroline N Goldfarb1,5,
  3. Stacey Leigh Rubin1,
  4. Jessica L Kuperstock1,2,
  5. Leah DiBianco1,
  6. Andrea Picciotto1,6
  1. 1DuPont Clinic, Washington, District of Columbia, USA
  2. 2The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
  3. 3Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Balitmore, Maryland, USA
  4. 4Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California, USA
  5. 5Harvard Medical School, Boston, Massachusetts, USA
  6. 6Kansas City University College of Osteopathic Medicine, Kansas City, Missouri, USA
  1. Correspondence to Dr Matthew F Reeves, DuPont Clinic, Washington, DC 20036, USA; mreeves5{at}jhu.edu

Abstract

Introduction We sought to assess the efficacy of transabdominal intrafetal lidocaine to achieve fetal demise before pregnancy termination.

Methods This study was a retrospective cohort analysis of patients undergoing transabdominal intrafetal lidocaine injections prior to abortion procedures after 24 weeks from January 2018 to June 2020 at DuPont Clinic, an outpatient obstetrics and gynaecology clinic in Washington, DC, USA. We recorded data on maternal factors, gestational age, time of injection and fetal asystole, and injection dose and location. We defined successful intrafetal lidocaine injection as asystole achieved prior to the patient leaving the clinic.

Results We performed injections in 338 fetuses in 335 patients, with a median gestational age of 27 weeks and 6 days (range 24–32 weeks). Lidocaine dose was 200–240 mg in 310 cases (91.7%) and 400–480 mg in 27 cases (8.0%) without difference in success (p>0.05). Lidocaine successfully induced fetal demise with one injection in 331 cases (97.9%). A second injection was required to induce demise for five fetuses (1.5%). Intracardiac injection was successful in 280 of 285 cases (98.3%), with asystole confirmed within 1 min in 75% of cases. Intrathoracic injection caused asystole in 45 of 47 cases (95.7%), with asystole confirmed within 2 min in 75% of cases. Success was not significantly associated with gestational age, body mass index or parity (p>0.05). One patient reported lidocaine-related side effects (0.3%).

Conclusions Intrafetal lidocaine is a safe and effective method of inducing fetal demise. Intracardiac injection achieves fetal asystole almost immediately. Intrathoracic injection is also highly effective.

  • abortion, induced
  • Abortifacient Agents
  • family planning services

Data availability statement

Data are not publically available.

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Data availability statement

Data are not publically available.

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Footnotes

  • Contributors MFR and CNG analysed the data and drafted the manuscript. LD, AP and CNG collected the data. SLR, JLK and MFR were involved in the conception and execution of the methods analysed in the manuscript and provided critical revision. MFR is the study guarantor and accepts full responsibility for the work and conduct of the study, had access to the data, and controlled the decision to publish. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding The authors did not receive a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MFR is a consultant to GenBioPro and Simple Health. He also serves on the board of directors of DKT International. All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years, and no other relationships or activities that could appear to have influenced the submitted work.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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