Transabdominal intrafetal lidocaine to induce fetal demise p
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Authors performed transabdominal intrafetal lidocaine injections to induce fetal demise prior to abortion procedures at 24 weeks and later. They examined the efficacy of these injections and evaluated their success by factors such as injection location and lidocaine dose.

Authors reviewed charts of all patients undergoing transabdominal intrafetal lidocaine injections, performed by 3 fellowship-trained obstetrician-gynecologists experienced in ultrasound guided procedures, prior to abortions from January 2018 through June 2020 at the DuPont Clinic, an outpatient ob-gyn clinic in Washington, DC. We recorded data on obstetric and medical history, weeks of pregnancy, time of injection and fetal asystole, dose and location of lidocaine injection. Ethical approval provided by the Stanford IRB. Successful intrafetal lidocaine injection was defined by asystole achieved.

Authors performed 342 injections in 338 fetuses from 335 patients undergoing an abortion procedure, with a median of 27 weeks and 6 days (range: 24–32 weeks). The lidocaine dose was 200 to 240 mg in 315 cases (92.1%) and 400 to 480 mg in 27 cases (7.9%). All injections were performed using 15-cm 20-gauge needles, under direct ultrasound guidance. Lidocaine successfully induced fetal demise with only 1 injection in 98.2% of cases with 4 patients requiring a second injection (1.8%). When confirmed to be intracardiac, injection was successful in 98.6% cases, with asystole confirmed within 1 minute in 75% of cases. Intrathoracic injections were successful in 95.7% of cases, with 75% of cases achieving asystole within 2 minutes. Success was not significantly associated with durations of pregnancy, BMI, or parity. One patient reported lidocaine-related side effects (0.3%).

Transabdominal intrafetal lidocaine is a safe and effective method of inducing fetal demise after 24 weeks. Further research should test varying intrafetal location and lidocaine dose.

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