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Induced fetal demise

Anna K Sfakianaki, MD
Joshua Copel, MD
Section Editor
Jody Steinauer, MD, MAS
Deputy Editor
Sandy J Falk, MD, FACOG


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 [4]. 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 [1]. 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 [6].

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Literature review current through: Nov 2017. | This topic last updated: Aug 29, 2017.
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  1. Jackson RA, Teplin VL, Drey EA, et al. Digoxin to facilitate late second-trimester abortion: a randomized, masked, placebo-controlled trial. Obstet Gynecol 2001; 97:471.
  2. Elimian A, Verma U, Tejani N. Effect of causing fetal cardiac asystole on second-trimester abortion. Obstet Gynecol 1999; 94:139.
  3. Diedrich J, Drey E, Society of Family Planning. Induction of fetal demise before abortion. Contraception 2010; 81:462.
  4. Ruano R, Dumez Y, Cabrol D, Dommergues M. Second- and third-trimester therapeutic terminations of pregnancy in cases with complete placenta previa--does feticide decrease postdelivery maternal hemorrhage? Fetal Diagn Ther 2004; 19:475.
  5. Fletcher JC, Isada NB, Pryde PG, et al. Fetal intracardiac potassium chloride injection to avoid the hopeless resuscitation of an abnormal abortus: II. Ethical issues. Obstet Gynecol 1992; 80:310.
  6. Dommergues M, Cahen F, Garel M, et al. Feticide during second- and third-trimester termination of pregnancy: opinions of health care professionals. Fetal Diagn Ther 2003; 18:91.
  7. Isada NB, Pryde PG, Johnson MP, et al. Fetal intracardiac potassium chloride injection to avoid the hopeless resuscitation of an abnormal abortus: I. Clinical issues. Obstet Gynecol 1992; 80:296.
  8. Chervenak FA, McCullough LB. An ethically justified practical approach to offering, recommending, performing, and referring for induced abortion and feticide. Am J Obstet Gynecol 2009; 201:560.e1.
  9. Giannakoulopoulos X, Sepulveda W, Kourtis P, et al. Fetal plasma cortisol and beta-endorphin response to intrauterine needling. Lancet 1994; 344:77.
  10. Lee SJ, Ralston HJ, Drey EA, et al. Fetal pain: a systematic multidisciplinary review of the evidence. JAMA 2005; 294:947.
  11. Mellor DJ, Diesch TJ, Gunn AJ, Bennet L. The importance of 'awareness' for understanding fetal pain. Brain Res Brain Res Rev 2005; 49:455.
  12. Senat MV, Fischer C, Bernard JP, Ville Y. The use of lidocaine for fetocide in late termination of pregnancy. BJOG 2003; 110:296.
  13. Nucatola D, Roth N, Gatter M. A randomized pilot study on the effectiveness and side-effect profiles of two doses of digoxin as fetocide when administered intraamniotically or intrafetally prior to second-trimester surgical abortion. Contraception 2010; 81:67.
  14. Pasquini L, Pontello V, Kumar S. Intracardiac injection of potassium chloride as method for feticide: experience from a single UK tertiary centre. BJOG 2008; 115:528.
  15. Sfakianaki AK, Davis KJ, Copel JA, et al. Potassium chloride-induced fetal demise: a retrospective cohort study of efficacy and safety. J Ultrasound Med 2014; 33:337.
  16. Senat MV, Fischer C, Ville Y. Funipuncture for fetocide in late termination of pregnancy. Prenat Diagn 2002; 22:354.
  17. Gill P, Cyr D, Afrakhtah M, et al. Induction of fetal demise in advanced pregnancy terminations: report on a funic potassium chloride protocol. Fetal Diagn Ther 1994; 9:278.
  18. Bhide A, Sairam S, Hollis B, Thilaganathan B. Comparison of feticide carried out by cordocentesis versus cardiac puncture. Ultrasound Obstet Gynecol 2002; 20:230.
  19. Coke GA, Baschat AA, Mighty HE, Malinow AM. Maternal cardiac arrest associated with attempted fetal injection of potassium chloride. Int J Obstet Anesth 2004; 13:287.
  20. Molaei M, Jones HE, Weiselberg T, et al. Effectiveness and safety of digoxin to induce fetal demise prior to second-trimester abortion. Contraception 2008; 77:223.
  21. Hern WM, Zen C, Ferguson KA, et al. Outpatient abortion for fetal anomaly and fetal death from 15-34 menstrual weeks' gestation: techniques and clinical management. Obstet Gynecol 1993; 81:301.
  22. Drey EA, Thomas LJ, Benowitz NL, et al. Safety of intra-amniotic digoxin administration before late second-trimester abortion by dilation and evacuation. Am J Obstet Gynecol 2000; 182:1063.
  23. Evans MI, Goldberg JD, Dommergues M, et al. Efficacy of second-trimester selective termination for fetal abnormalities: international collaborative experience among the world's largest centers. Am J Obstet Gynecol 1994; 171:90.
  24. Robyr R, Yamamoto M, Ville Y. Selective feticide in complicated monochorionic twin pregnancies using ultrasound-guided bipolar cord coagulation. BJOG 2005; 112:1344.
  25. Lewi L, Gratacos E, Ortibus E, et al. Pregnancy and infant outcome of 80 consecutive cord coagulations in complicated monochorionic multiple pregnancies. Am J Obstet Gynecol 2006; 194:782.
  26. Moise KJ Jr, Johnson A, Moise KY, Nickeleit V. Radiofrequency ablation for selective reduction in the complicated monochorionic gestation. Am J Obstet Gynecol 2008; 198:198.e1.
  27. Quintero RA, Romero R, Reich H, et al. In utero percutaneous umbilical cord ligation in the management of complicated monochorionic multiple gestations. Ultrasound Obstet Gynecol 1996; 8:16.