{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T19:13:03Z","timestamp":1788289983582,"version":"build-2803163510"},"reference-count":19,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100012297","name":"Society of Family Planning","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012297","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Perspect Sexual Reproductive"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The study's purpose was to determine the safety of two routes and doses of digoxin through assessment of systemic absorption, cardiac rhythm, and coagulation parameters injected as part of second\u2010trimester dilation and evacuation abortion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We randomized pregnant women between 19 and 23\u2009weeks' gestation to receive either 1.5\u2009mg digoxin through intra\u2010amniotic injection (IAI) or 1.0\u2009mg through intrathoracic injection (IFI). We measured subjects' serum digoxin levels and coagulation indices over 48\u2009h post\u2010injection and cardiac rhythm monitoring for 24\u2009h.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Ten patients in each group completed the study. All injections caused fetal demise within 24\u2009h. In the IAI group, mean (\u00b1SD) digoxin peak concentration in the IAI group was 1.5. \u00b10.72 (range 0.7\u20132.9\u2009ng\/mL); in the IFI group 1.4\u2009\u00b1\u20090.74\u2009ng\/mL (range 0.5\u20132.4\u2009ng\/mL). Mean (\u00b1SD) time to peak digoxin level in the IAI group was 10.7\u2009\u00b1\u20098.5\u2009h (range, 1\u201324\u2009h); in the IFI group 1.5\u2009\u00b1\u20090.97\u2009h (range, 1\u20134\u2009h,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Five patients had laboratory\u2010defined critical digoxin levels of uncertain significance. Cardiac rhythm monitoring showed no digoxin\u2010associated rhythm or conduction abnormalities. Prothrombin and partial thromboplastin time levels remained normal in both groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Neither 1.5\u2009mg IAI nor 1.0\u2009mg IFI of digoxin administered to induce fetal demise was associated with adverse maternal cardiac outcomes or coagulation parameter changes. Serum levels reflected significant digoxin absorption in both groups, generally resulting in maximum digoxin concentration peaks in the low therapeutic range. Injecting digoxin to cause fetal demise in abortion care appears safe and effective.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/psrh.70081","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T18:18:30Z","timestamp":1788286710000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Safety of Intra\u2010Amniotic and Intra\u2010Fetal Digoxin Administration in Late Second\u2010Trimester Abortion by Dilation and Evacuation"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-2258-9190","authenticated-orcid":false,"given":"Eleanor A.","family":"Drey","sequence":"first","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Science University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora","family":"Goldschlager","sequence":"additional","affiliation":[{"name":"Department of Medicine University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2041-8124","authenticated-orcid":false,"given":"Neal L.","family":"Benowitz","sequence":"additional","affiliation":[{"name":"Department of Medicine University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abby","family":"Sokoloff","sequence":"additional","affiliation":[{"name":"The Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences School of Medicine, University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3569-8166","authenticated-orcid":false,"given":"Rebecca A.","family":"Jackson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Science University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0020\u20107292(01)00478\u20107"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0029\u20107844(00)01148\u20100"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2015.05.002"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2024.08.048"},{"key":"e_1_2_9_6_1","unstructured":"WHO \u201cClinical Practice Handbook for Quality Abortion Care \u201d(2024)."},{"key":"e_1_2_9_7_1","unstructured":"FIGO \u201cFIGO Position Statement on the Recent Prohibition of Induction of Fetal Asystole for Legal Abortions in Brazil|Figo \u201d(2024)."},{"key":"e_1_2_9_8_1","unstructured":"Congress \u201cText\u2014S.3\u2014108th Congress (2003\u20102004): Partial\u2010Birth Abortion Ban Act of 2003 | Congress.gov | Library of Congress \u201d(2024)."},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2008.11.010"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2007.10.011"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001671"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2011.05.016"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2000.105438"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471\u20100528.15640"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2011.01.005"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650802071703"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2009.12.001"},{"key":"e_1_2_9_18_1","volume-title":"Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine","author":"Bonow R. 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