Induction of fetal demise in advanced pregnancy terminations: report on a funic potassium chloride protocol.

Abstract

Advanced pregnancy termination with uterotonic agents with their inherent risk for occurrence of a live birth and surgical evacuation of a fetus perceived to be vigorous can both be sources of emotional anguish for women. They argue for offering women an option for induction of fetal demise prior to uterine evacuation. We report on our experience with 60 pregnancies in which lethal fetal administration of potassium chloride was performed prior to evacuation of the uterus. We describe a double-bolus technique for funic intravascular injection of potassium chloride to arrest the fetal heart. There were no maternal complications and the procedure was successful in 86.7% (n = 52) of the cases; of the remaining 8 cases, 7 had demise induced by direct fetal cardiac injection, and a live birth occurred in 1 case.