The safety and efficacy of digoxin as a feticidal agent prior to second trimester abortion
Awarded 2008
Large Research Grants
Gillian Dean, MD, MPH
Planned Parenthood of New York City

Approximately 140,000 second trimester abortions are performed in the US each year. Second trimester abortion is most commonly performed by a technique known as dilation and evacuation. Clinicians use digoxin, a drug commonly used for cardiac conditions, to facilitate pregnancy termination in the late second trimester. When injected into the fetus or amniotic fluid, digoxin causes fetal death and softening of fetal tissue. In response to the 2007 Supreme Court decision upholding the Partial Birth Abortion Act, many abortion providers instituted routine use of digoxin prior to second trimester abortion. Despite relatively widespread use, published data on the safety and efficacy of digoxin in abortion care are limited. Our primary objective was to determine whether digoxin prior to dilation and evacuation is associated with higher or lower rates of complications than dilation and evacuation without digoxin. Our secondary objective was to determine the efficacy of digoxin to cause fetal death by gestational age and injection site. We conducted a retrospective review of the medical records of two groups of patients at an urban family planning clinic. One group had received digoxin before their dilation and evacuation procedures. The other group, from the 15 months prior to the initiation of routine digoxin use at the clinic, had undergone dilation and evacuation without digoxin. We collected data on patient medical history, their abortion procedure, and complications. We found no significant differences in gestational age, number of vaginal births, cesarean deliveries, and use of laminaria between the two groups. We found statistically significant differences in the occurrence of miscarriage and infection in the two groups, with the digoxin group showing higher incidence of both complications. There were no significant differences in other complications. In addition, we found that digoxin achieved fetal death 92% of the time. Intrathoracic and intraabdominal injections were associated with the lowest rates of failure. We did not find an association between the efficacy of digoxin and gestational age. We concluded that cligoxin injection before dilation and evacuation is associated with greater rates of spontaneous abortion and infection than dilation and evacuation without digoxin. Digoxin is not associated with differences in the rates of other complications.