Intrafetal Digoxin as an Adjuvant for Dilation and Evacuation at 20 to 24 Weeks' Gestation

Intrafetal Digoxin as an Adjuvant for Dilation and Evacuation at 20 to 24 Weeks' Gestation: a Placebo-controlled, Double-blinded Randomized Controlled Trial

This is a research study to measure the effect of digoxin injection on Dilation and Evacuation (D&E) procedure duration. Digoxin is the most commonly used feticidal agent among family planning subspecialists, and is commonly used for a variety of reasons including provider preference, patient preference, and concerns over legal status of later D&E procedures. There have been several studies on digoxin administration, adverse effects, and impact on the D&E procedure, but doctors want to clarify how digoxin effects D&E procedure time, if at all.

Subjects assigned to the intervention arm will receive a 1 mg intrafetal digoxin injection under ultrasound guidance

Subjects assigned to the control arm will receive an ultrasound-guided intrafetal saline injection of the equivalent volume

Time from speculum placed until all instruments removed from vagina (including speculum and fingers) and done with everything

measured blood loss, in mL, during the procedure, measured by weighing the absorbent materials used and subtracting out their weight without blood

hemorrhage, perforation, cervical laceration requiring suture repair, out-of-hospital delivery, infection, inability to complete injection, other complications of the injection itself, and patient symptoms such as nausea and vomiting

Inclusion Criteria: 20 weeks 0 days-24 weeks 0 days gestation English or Spanish speaking 18 years or older Exclusion Criteria: Under 18 Contraindications to digoxin