Chorioamnionitis in the Setting of Laminaria and Intra-Amniotic Digoxin: A Case Report View PDF

^*Lindsey A Roth
Department Of Obstetrics And Gynecology, New York University School Of Medicine, New York, 10012, United States

^*Corresponding Author:

Lindsey A Roth
Department Of Obstetrics And Gynecology, New York University School Of Medicine, New York, 10012, United States
Email:Lindsey.roth@nyulangone.org

Published on: 2023-06-13

Abstract

Background: Laminaria placement and digoxin injection for induced abortion are safe procedures. However, there remains a theoretical risk of bacteria ascending into the cervix and uterus, leading to possible infection. Very few studies and case reports exist regarding infection with laminaria placement and digoxin injection and the use of antibiotic prophylaxis for these procedures.
Case: Herein, we present a case of chorioamnionitis after laminaria placement and intra-amniotic digoxin injection in a patient with intact membranes prior to a dilation and evacuation procedure.
Conclusion: Although infection with laminaria placement and digoxin injection is rare, additional research is warranted. The use of prophylactic antibiotics at the time of laminaria placement and digoxin injection should be further explored, especially in patients with risk factors.

Keywords

Chorioamnionitis; Laminaria; Intra Amniotic Digoxin; Digoxin Injection; Prophylaxis

Background

Infection as a complication of induced abortion is rare. Studies have found risk of infection in the setting of induced abortion is approximately 1%, especially in the setting of perioperative prophylaxis [1]. However, there have been no trials looking at the infection risk of osmotic dilators in second trimester termination, and only a few case reports of infection after osmotic dilator placement [2,3]. Infection risk with osmotic dilator placement is low, likely due to sterilization by irradiation or ethylene oxide gas and removal of osmotic dilators within 12 to 48 hours after insertion [4]. However, there remains a theoretical risk of vaginal bacteria ascending into the cervix and uterus, leading to possible infection.
Furthermore, some research has examined risk of infection after intra-amniotic digoxin. One retrospective cohort study compared infection rates among those undergoing termination between 18- 24 weeks who received digoxin versus those who did not and found the digoxin cohort had a greater likelihood of signs of infection [5]. Another large case series found infection rates after digoxin to be 0.3%, however all patients with infection had rupture of membranes prior to procedure [6]. One additional study looking at 4,906 dilation and evacuation procedures with digoxin injection reported only two cases with infection, with one post- and one pre-procedure [7]. These studies demonstrate the low infection rate among those who receive digoxin injections, and thus intra-amniotic digoxin is thought to be safe.
Herein, we present a case of chorioamnionitis diagnosed after laminaria placement and intra-amniotic digoxin injection in a patient with intact membranes prior to a dilation and evacuation procedure.