Research
General gynecology
Outcome following high-dose methotrexate in pregnancies misdiagnosed as ectopic

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Objective

The objective of this study was to report the outcomes of intrauterine pregnancies misdiagnosed as ectopic and exposed to methotrexate, a major teratogen.

Study Design

We report the outcomes of all subjects who sought consultation after exposure to high-dose methotrexate to induce abortion in presumed ectopic pregnancies, which were later identified as viable intrauterine pregnancies by 3 North American Teratology Information Services between 2002 and 2010.

Results

Eight women with normal, desired pregnancies were administered high-dose methotrexate in the first trimester because of presumed, misdiagnosed ectopic pregnancies. All pregnancies resulted in catastrophic outcomes. Two pregnancies resulted in severely malformed newborns with methotrexate embryopathy; 3 women miscarried shortly after exposure, and in 3 the erroneous diagnosis led the physicians to advise and perform surgical termination.

Conclusion

Erroneous diagnosis of intrauterine pregnancies as ectopic with subsequent first-trimester exposure to methotrexate may result in the birth of severely malformed babies or fetal demise.

Section snippets

Methods

We collected cases among callers (both physicians and patients), who sought consultation by one of 3 Teratology Information Service Centers: The Motherisk Program, The Hospital for Sick Children, Toronto; The California Teratogen Information Service, University of California, San Diego; and the Connecticut Pregnancy Exposure Information Service, West Hartford, between January 1, 2002 and April 30, 2010. All of the callers who were seeking advice in regards to first-trimester exposure to

Results

We identified 8 presumed ectopic pregnancies, for which high-dose methotrexate was administered, with subsequent confirmation of viable intrauterine pregnancies. Four of these were initially diagnosed by hospital emergency department physicians and the remainder by Obstetricians/Gynecologists.

None of the 8 pregnancies resulted in the birth of a healthy newborn (Table). Two pregnancies continued to delivery. The first resulted in a term, severely malformed newborn, with features consistent with

Discussion

The misdiagnosis of desired, intrauterine pregnancies as ectopic with subsequent exposure to high-dose methotrexate during embryogenesis may result in the birth of severely malformed babies, miscarriage, or induced abortion.

In recent years, the diagnosis of an ectopic pregnancy has often been made in the emergency department setting, by personnel who may be less experienced in prenatal ultrasound imaging, as part of lower abdominal pain or vaginal bleeding work-up in young women, as in half of

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Cited by (0)

The authors report no conflict of interest.

Cite this article as: Nurmohamed L, Moretti ME, Schechter T, et al. Outcome following high-dose methotrexate in pregnancies misdiagnosed as ectopic. Am J Obstet Gynecol 2011;205:533.e1-3.

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