Prenatal diagnosis of methotrexate embryopathy.
BACKGROUND
Methotrexate is an antineoplastic agent used by obstetrician-gynecologists for termination of early pregnancy. The drug is not always successful and is associated with a known array of malformations.


METHODS
We present a case of a failed pregnancy termination with methotrexate, which resulted in fetal anomalies. Ultrasound revealed absent or markedly shortened long bones, abnormal positioning of the hands, micrognathia, echogenic bowel, and a two-vessel umbilical cord. The patient elected to undergo pregnancy termination, and the ultrasound findings were confirmed at autopsy.


CONCLUSIONS
Because of methotrexate's teratogenic potential, follow-up to confirm successful termination is necessary. Ultrasound evaluation of the fetus is indicated if pregnancy termination is unsuccessful.
Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois 60637, USA. jchapa33@yahoo.com
Jeff B
JB
Chapa
Judith U
JU
Hibbard
Elyse M
EM
Weber
Jacques S
JS
Abramowicz
Marion S
MS
Verp
D000014:Abnormalities, Drug-Induced / Q000000981:diagnostic imaging* / Q000209:etiology*; D000020:Abortifacient Agents, Nonsteroidal / Q000009:adverse effects*; D000028:Abortion, Induced; D000328:Adult; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects*; D011247:Pregnancy; D017211:Treatment Failure; D016216:Ultrasonography, Prenatal
D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate