title: Anomalies associated with failed methotrexate and misoprostol termination.
abstract: BACKGROUND
  Methotrexate and misoprostol are frequently used in combination for medical termination of pregnancy. Despite their frequent use, published information about low-dose exposures to these known teratogens is sparse and neonatal follow-up data are limited. We present neonatal outcomes in three infants from two different women who had failed medical terminations with methotrexate and misoprostol.
  
  
  METHODS
  A young gravida 1, para 0, presented with intrauterine pregnancy complicated by first-trimester exposure to oral methotrexate and vaginal misoprostol. Ultrasonography determined that the fetus had intrauterine growth restriction and ventriculomegaly. The infant had growth and developmental delays. A young gravida 4, para 3-0-0-3, also presented after first trimester exposure to methotrexate and misoprostol, and was found to have a twin gestation. The infants were noted to have multiple congenital anomalies, growth restriction, and developmental delay.
  
  
  CONCLUSIONS
  Even single doses of methotrexate and misoprostol used in medical termination of pregnancy can be associated with multiple congenital anomalies.
authors.affiliation: Department of Family Practice and Division of Maternal-Fetal Medicine, Womack Army Medical Center, Fort Bragg, North Carolina 28310-5700, USA. Nicole.T.Yedlinsky@us.army.mil
authors.forename: Nicole T
authors.initials: NT
authors.lastname: Yedlinsky
authors.forename: Frank C
authors.initials: FC
authors.lastname: Morgan
authors.forename: Paul W
authors.initials: PW
authors.lastname: Whitecar
mesh_terms: D000027:Abortion, Incomplete; D000028:Abortion, Induced / Q000009:adverse effects / Q000379:methods; D000328:Adult; D000013:Congenital Abnormalities / Q000000981:diagnostic imaging / Q000209:etiology*; D002658:Developmental Disabilities / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005333:Fetus / Q000002:abnormalities*; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D016595:Misoprostol / Q000009:adverse effects* / Q000627:therapeutic use; D011247:Pregnancy; D011256:Pregnancy Outcome; D018570:Risk Assessment; D016216:Ultrasonography, Prenatal
chemical_list: D016595:Misoprostol; D008727:Methotrexate