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Comparison between potassium chloride and lidocaine as lethal agents for feticide in termination of pregnancy

2018; Wiley; Volume: 53; Issue: 4 Linguagem: Inglês

10.1002/uog.19059

1469-0705

Romy Rayssiguier, Yuri Musizzano, Martha Julia Matos Pérez, E. Mousty, A. Ménard, P. Boulot, Coralie Dumont, F. Fuchs,

Prenatal Screening and Diagnostics

In France, termination of pregnancy (TOP) can be performed regardless of gestational age if the fetus is at high risk for a severe and uncorrectable condition or the mother's health is compromised, and there is medical approval. After 22 weeks of gestation, feticide is legally and ethically required before terminating the pregnancy1. We performed a 9-month prospective observational multicenter study comparing, for the first time, the use of two lethal agents, potassium chloride (KCl) and lidocaine. Outcomes studied were time from administration of lethal agent to fetal asystole2, 3, maternal tolerance4 and quality of the pathological data5. After epidural anesthesia, the procedure consisted of an ultrasound-guided puncture, using a 20-gauge needle, of the fetal umbilical vein or, in case of technical difficulty, of the fetal heart, followed by injection of 1.5 μg of sufentanil per kg of estimated fetal weight, and, finally, immediate injection of 100 mg (10 mL) of 1% lidocaine or 1 g (10 mL) of 10% KCl. The injection could be repeated once if fetal asystole did not occur after 1 min (maximum overall dose of 200 mg of lidocaine or 2 g of KCl). In cases in which feticide was performed for fetal anomaly, pathologists, who were blinded to the type of lethal agent used, evaluated the quality of micro- and macroscopic pathological data. Of the 37 cases of TOP included in the study, 18 were in the lidocaine group and 19 in the KCl group (Table 1). The mean time to fetal asystole did not differ significantly between the two groups: 1.66 (1–4.19) min in the lidocaine group vs 2.33 (0.61–2.83) min in the KCl group (P = 0.67). No serious side effect suggesting maternal intolerance was observed. Three cases of vasovagal reaction were observed in each group. In the KCl group, within 1 min following the injection of the lethal agent, one woman described the onset of a metallic taste in her throat, while another woman experienced a 15-s sensation of generalized paralysis, without loss of consciousness, which resolved spontaneously. Both of these women had received the minimum dose of KCl (10 mL) by the intrafunicular route. A pathological examination was conducted, with the mother's consent, in 54.1% of fetuses. The use of lidocaine or KCl was systematically associated with cell lysis. There was no significant difference between the groups in the degree of maceration, congestion, lysis or presence of crystals in the viscera (P = 1.00 for all) (Table 2 and Figure 1). In conclusion, our study showed that the use of KCl vs lidocaine for feticide in TOP does not influence the time to fetal asystole nor does it impede pathological analysis. The risk due to the possible passage of KCl to the maternal circulation indicates that lidocaine use is preferable. This work also shows the possibility of improving feticide protocols, especially regarding the management of fetal analgesia.