Objective: To describe effectiveness of funic potassium chloride (KCl) injection for fetal demise during intact dilation and evacuation (D&E).
Study design: We abstracted medical records of patients who underwent standard or intact D&E to identify those who had intact D&E from 20 weeks 0 days through 23 weeks 6 days from February 2016 to August 2017 at one academic center. We extracted data on time to asystole following KCl injection, as well as incidents including hemorrhage, infection, uterine perforation, and unplanned admissions for up to 6 months following each procedure.
Results: Of 57 procedures, 32 (56%) were intact. Median time from KCl injection to fetal asystole was 48 seconds (interquartile range [IQR] 34-100). Median time to asystole at weeks 20 and 21 (46 seconds [IQR 34-60 seconds]) did not differ significantly from weeks 22 and 23 (85 seconds [IQR 34-200 seconds]), p = 0.15. Asystole occurred in less than four minutes in all cases but one. No adverse events occurred with either the funic KCl injections or the intact D&E procedures.
Conclusion: Funic KCl injection for intact D&E usually causes fetal asystole in less than 4 minutes.
Implications: Funic KCl injection under direct visualization is a feasible method to induce fetal asystole at the time of intact dilation and evacuation.
Keywords: Abortion; Dilation and evacuation; Fetal demise; Feticide; Potassium chloride; Second trimester.
Published by Elsevier Inc.