Induction of Fetal Asystole Before Abortion
Publication Date: September 11, 2024
Last Updated: September 22, 2024
Summary of Recommendations
Insufficient evidence exists to recommend routine induction of fetal asystole before a previable medication abortion. (, )
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Insufficient evidence exists to recommend routine induction of fetal asystole before a previable procedural abortion because it has not been shown conclusively to improve the ease of procedure or reduce complications during dilation and evacuation. (, )
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At periviable gestations and after fetal viability, induction of fetal asystole before abortion prevents the infrequent but serious occurrence of unanticipated expulsion of a fetus with cardiorespiratory activity (Best Practice). Defining viability is complicated as it represents a physiological continuum impacted by gestational duration along with multiple other individual clinical factors and circumstances; therefore, the exact gestational duration to offer fetal asystole will depend on the setting and clinical circumstances. (, )
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Insufficient evidence exists to recommend routine induction of fetal asystole before a previable procedural abortion because it has not been shown conclusively to improve the ease of procedure or reduce complications during dilation and evacuation. However, at periviable gestations and after fetal viability, induction of fetal asystole before procedural abortion prevents the infrequent but serious occurrence of unanticipated expulsion of a fetus with cardiorespiratory activity. (Best Practice Recommendation) (, )
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If induction of fetal asystole before abortion is available, we recommend engaging in patient-centered counseling regarding the risks and benefits of induction of fetal asystole in the setting of each unique pregnancy scenario and the patient’s beliefs and priorities. (Best Practice Recommendation) (, )
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We recommend that clinicians identify the optimal pharmacologic agent to administer for a given clinical scenario based on factors such as availability of each agent; the time frame in which fetal asystole needs to be established; and clinicians’ technical ability, preferences, and practice (Best Practice Recommendation) (, )
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Potassium chloride, lidocaine, and digoxin are all acceptable pharmaceutical agents to induce fetal asystole before abortion. To establish asystole rapidly, we suggest using potassium chloride (via intracardiac or intrafunic injection) or lidocaine (via intracardiac or intrafunic injection), although intrathoracic administration of lidocaine may be acceptable. (2, C)
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We recommend potassium chloride not be used if intracardiac or intrafunic location cannot be achieved to avoid the risk of accidental administration to the pregnant individual and because insufficient data support its efficacy via other intrafetal locations. (1, C)
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When using digoxin, we recommend intrafetal administration, although intraamniotic administration may be acceptable depending on a clinician’s technical ability and setting. Because digoxin may take several hours to induce asystole, an alternative agent should be considered in settings where fetal asystole must be confirmed rapidly. (1, C)
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Recommendation Grading
Disclaimer
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.
Overview
Title
Induction of Fetal Asystole Before Abortion
Authoring Organization
Society of Family Planning
Publication Month/Year
September 11, 2024
Last Updated Month/Year
September 22, 2024
Document Type
Consensus
Country of Publication
US
Document Objectives
This document serves as a revision to the Society of Family Planning’s 2010 guidelines, integrating literature on new techniques and research and addressing the clinical, medical, and sociolegal questions surrounding the induction of fetal asystole.
Inclusion Criteria
Female, Adolescent, Adult
Health Care Settings
Ambulatory, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Management
Diseases/Conditions (MeSH)
D000028 - Abortion, Induced
Keywords
abortion, Fetal Asystole
Source Citation
10.1016/j.contraception.2024.110551