Induced fetal demise
- Anna K Sfakianaki, MD
Anna K Sfakianaki, MD
- Associate Professor
- Obstetrics, Gynecology and the Reproductive Sciences
- Yale University School of Medicine
- Joshua Copel, MD
Joshua Copel, MD
- Obstetrics, Gynecology and the Reproductive Sciences, and Pediatrics
- Yale University School of Medicine
Induced fetal demise (also called iatrogenic fetal demise, feticide or fetocide) refers to the injection of a pharmacologic agent into a fetus to cause its demise. The procedure is usually performed as an adjunct to mid to late second trimester termination of pregnancy, but is also performed for selective or nonselective reduction of one or more fetuses in a multiple gestation. These issues are discussed in detail separately. (See "Multifetal pregnancy reduction and selective termination" and "Overview of second-trimester pregnancy termination".)
Facilitation of abortion — In theory, softening and loosening of fetal tissues and hormonal changes related to fetal demise should facilitate subsequent uterine evacuation. This has not been studied rigorously; however, the available data regarding pregnancy termination after induced fetal demise have not consistently observed a reduction in the duration of the procedure [1-3].
For patients with placenta previa undergoing medical termination of pregnancy, a case-control study including 15 pregnancies reported that preinduction feticide decreased the risk of transfusion . This finding needs to be confirmed in larger trials.
Patient/provider preference — As discussed above, standard methods of pregnancy termination via labor induction do not ensure fetal demise during the procedure. A live birth in this setting can be psychologically and emotionally difficult for the family and staff; feticide removes this possibility [3,5]. In a randomized placebo controlled trial of digoxin to facilitate late second-trimester abortion, 91 percent of patients indicated that they preferred their fetuses be dead prior to the procedure . This has also been our experience; we have observed that patients who undergo abortion in the late second trimester are very amenable to induced fetal demise.
Providers also generally favor induced fetal demise prior to the abortion procedure, for all of the reasons cited above .
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- Facilitation of abortion
- Patient/provider preference
- Legal issues
- Third trimester abortion
- CHOICE OF AGENT
- Potassium chloride
- Intracardiac injection
- Intraumbilical vein injection
- Intraamniotic injection of digoxin
- SIDE EFFECTS AND COMPLICATIONS
- Potassium chloride
- SELECTIVE TERMINATION IN THE SECOND TRIMESTER
- SUMMARY AND RECOMMENDATIONS