The use of lidocaine for fetocide in late termination of pregnancy

Abstract

OBJECTIVE: To assess the use of lidocaine (1%) to induce permanent fetal cardiac asystole for fetocide in late termination of pregnancy. DESIGN: Prospective observational study. SETTING: One tertiary referral fetal medicine unit in France. SAMPLE: Fifty patients undergoing termination of pregnancy between 20 and 36 weeks of gestation for severe abnormalities or severe maternal conditions. METHODS: Fetocide was performed by umbilical vein puncture under ultrasound guidance with injection of sufentanil (5 microg) followed by 7 to 30 mL of lidocaine (1%). MAIN OUTCOME MEASURES: Percentage of successful procedures to obtain permanent fetal cardiac asystole and maternal side effects. RESULTS: The procedure was successful in 92% of cases (46/50) with complete cessation of heart activity. The mean amount of lidocaine was 15.3 (6.5) mL. In three cases, fetocide was performed by cardiocentesis and in one case lidocaine was unsuccessful and fetocide was performed with KCl. There were no maternal side effects. CONCLUSIONS: Lidocaine is an effective drug to perform fetocide with doses below the toxic dose for the mother.