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Wrongly ID’d Ectopic Pregnancy + Methotrexate Catastrophic

Last Updated: November 30, 2011.

Misdiagnosis of intrauterine pregnancies as ectopic, with subsequent first-trimester exposure to high-dose methotrexate, may result in severely malformed newborns or fetal deaths, according to a study published in the December issue of the American Journal of Obstetrics & Gynecology.

WEDNESDAY, Nov. 30 (HealthDay News) -- Misdiagnosis of intrauterine pregnancies as ectopic, with subsequent first-trimester exposure to high-dose methotrexate, may result in severely malformed newborns or fetal deaths, according to a study published in the December issue of the American Journal of Obstetrics & Gynecology.

Laila Nurmohamed, M.D., from the University of Toronto, and colleagues reported the outcomes of eight intrauterine pregnancies that were misdiagnosed as ectopic. All subjects were exposed to high-dose methotrexate in the first trimester to induce abortion in the presumed ectopic pregnancies, which were later identified as viable intrauterine pregnancies.

The investigators found that all of the pregnancies resulted in catastrophic outcomes. In two of the pregnancies, newborns were severely malformed, with methotrexate embryopathy. Three women were advised to undergo surgical termination, and three women miscarried shortly after exposure to methotrexate.

"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," the authors write. "Effective, nonpunitive reporting mechanisms should be sought, to determine the true magnitude of this phenomenon and to facilitate improvement in point-of care diagnostic accuracy of early ectopic pregnancies."

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