Late termination of pregnancy by intracardiac potassium chloride injection: 5 years' experience at a tertiary referral centre

Abstract

Objectives. To report our experience with intracardiac potassium chloride (KCl) injection as a method of feticide for severe congenital abnormalities beyond 24 weeks' gestation. Method. A retrospective chart review. Patient demographics and types of fetal anomalies were analysed according to the groups that accepted or declined late termination of pregnancy (LTOP, ≥24 weeks) for severe congenital abnormalities. Results. Of 3 896 women referred to the Fetal Medicine Unit at Inkosi Albert Luthuli Central Hospital, KwaZulu-Natal, 2 209 (56.7%) were at ≥24 weeks' gestation at their first visit. LTOP for severe congenital abnormalities was offered to 253 (11.5%), of whom 191 (75.5%) accepted. Differences in maternal age, parity, race and religion were not statistically significant. The type of fetal abnormalities and gestational age at diagnosis influenced the decision-making process in >80% of the women. The most frequent indications for LTOP were brain and spinal abnormalities (53.0%), and aneuploidy (20.6%). Feticide by ultrasound-guided intracardiac KCl injection was performed in 138/191 cases (72.2%); 53 women who accepted LTOP did not undergo feticide for a variety of reasons. The mean interval between diagnosis and performance of feticide was 10 days (range 0 -42 days). Fetal asystole was achieved in all cases within 2 minutes by a single-needle injection of intracardiac KCl; the mean duration of the procedure was 12 minutes (range 6 -25 minutes). There were no maternal complications, and stillbirths occurred in all cases. Conclusion. Feticide by ultrasound-guided intracardiac KCl injection was an acceptable, safe and effective method for LTOP. Further studies are needed to determine the minimum dosage of KCl required to achieve the desired effect.

Termination of Pregnancy for Medical Indications under Sec. 218a Para. 2 of the German Criminal Code – Real-life Data from the “Gießen Model”

“…After steps have been taken to terminate the pregnancy, the fetus will either be delivered or the pregnancy terminated, with delivery or termination taking place in some cases several days later. In the great majority of cases, the feticide is carried out by means of an injection of potassium chloride; if the duration of pregnancy is less than 20 completed weeks of gestation, induction of abortion in itself can be one option if the fetus is not viable outside the uterus [13,14,26]. In Germany screening using ultrasound for diagnosis is generally carried out at around the 20th week of gestation.…”

“…2 StGB in Germany. There are a number of individual studies and publications from other countries on the problem of so-called late terminations [13][14][15][16].…”

Partial-birth abortion – is it legally and ethically justifiable? Lessons for South Africa

“…[14] However, there are ways in which to humanely induce fetal demise before LTOP. It is recommended that physicians utilise the feticidal agent intracardiac potassium chloride to achieve painless fetal demise [97] in conjunction with the LTOP procedure consented to by the patient, including D and X. Alternatively, physicians should employ NPC when LTOP is not required, or when the patient refuses LTOP and her health permits her to deliver the fetus. NPC is specifically recommended in cases where the neonate is extremely premature, suffers from a lethal condition or is subjected to unbearable pain, and treatment is futile.…”

“…[14] Administration of the agent into the left ventricle of the heart will culminate in asystole, ensuring painless fetal demise. [14,97] Thereafter the physician should perform the LTOP procedure that has been consented to by the patient. [14] Alternatively, where LTOP does not necessitate D and X to avert irreparable harm, or death to the patient, or because of fetal malformation, and the patient wishes to deliver the fetus, provided it is safe to do so, physicians should utilise neonatal palliative care (NPC).…”

Editor's Choice

“…Experience with late termination of pregnancy (TOP) by intracardiac injection of potassium chloride is described by Govender and Moodley. 6 The South African Choice on Termination of Pregnancy Act, No. 92 of 1996, permits TOP at any gestational age for severe fetal abnormalities, to prevent the birth of a severely mentally or physically handicapped child.…”