title: Failed methotrexate termination of pregnancy: a case report.
abstract: We report a case of a fetus with shortened proximal long bones, ambiguous genitalia, intrauterine growth restriction and abnormal umbilical artery Doppler velocities observed on antenatal ultrasound exam. At 34 weeks the patient revealed methotrexate/misoprostol exposure at 6 weeks gestational age in attempted medical termination of pregnancy. On newborn exam, the baby had dysmorphic facial features, a short torso, scoliosis, a micropenis (phallus <1 cm) and shortened proximal long bones both upper and lower extremities. X-ray exam revealed a hemivertebra at T10 level, rib abnormalities, shortened proximal long bones, an absent pubic bone and bilateral knee ossification centers. With methotrexate exposure, improved counseling and surveillance could potentially avoid these significant abnormalities and prevent psychological distress.
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, Jacobi Medical Center, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY 10461, USA.
authors.forename: D
authors.initials: D
authors.lastname: Goffman
authors.forename: D S
authors.initials: DS
authors.lastname: Cole
authors.forename: P
authors.initials: P
authors.lastname: Bobby
authors.forename: D J
authors.initials: DJ
authors.lastname: Garry
mesh_terms: D000015:Abnormalities, Multiple / Q000139:chemically induced*; D000020:Abortifacient Agents, Nonsteroidal / Q000009:adverse effects*; D000028:Abortion, Induced; D000328:Adult; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008727:Methotrexate / Q000009:adverse effects*; D016595:Misoprostol / Q000009:adverse effects*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol; D008727:Methotrexate