American Journal of Obstetrics and Gynecology
ResearchGeneral gynecologyOutcome following high-dose methotrexate in pregnancies misdiagnosed as ectopic
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.