title: Importance of timing of gestational exposure to methotrexate for its teratogenic effects when used in setting of misdiagnosis of ectopic pregnancy.
abstract: OBJECTIVE
  To report a case of embryopathy due to misadministration of methotrexate in the setting of suspected ectopic pregnancy that resulted in a different pattern of malformations than is typically seen with methotrexate.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Community hospital.
  
  
  METHODS
  A 30-year-old primigravida women exposed to methotrexate (50 mg/m(2)) at 5 6/7 weeks' gestation.
  
  
  METHODS
  The patient underwent amniocentesis because of abnormal results at the first-trimester genetic screening (low levels of pregnancy associated plasma protein A and hCG) and fetal echocardiogram because of single umbilical artery.
  
  
  METHODS
  Fetal anomalies.
  
  
  RESULTS
  The fetus was found to have a single umbilical artery, tetralogy of Fallot, and a "horseshoe lung," despite administration of high doses of folic acid. The pregnancy ultimately ended with fetal demise at 30 weeks.
  
  
  CONCLUSIONS
  As medical management of ectopic pregnancy becomes more common, practitioners should be cautious about the potential teratogenic effects in unrecognized intrauterine pregnancies and be able to diagnose the myriad defects, including cardiac anomalies, that could result from such exposure.
authors: Brock Family Perinatal Diagnostic Center, Inova Alexandria Hospital, Alexandria, VA 22304, USA. sarah.poggi@inova.org
authors: Sarah H
authors: SH
authors: Poggi
authors: Alessandro
authors: A
authors: Ghidini
mesh_terms: D000015:Abnormalities, Multiple / Q000139:chemically induced*; D000020:Abortifacient Agents, Nonsteroidal / Q000009:adverse effects*; D000328:Adult; D003951:Diagnostic Errors; D005260:Female; D005313:Fetal Death; D005315:Fetal Diseases / Q000139:chemically induced; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis / Q000188:drug therapy*; D058529:Single Umbilical Artery / Q000139:chemically induced; D013723:Teratogens / Q000633:toxicity*; D013771:Tetralogy of Fallot / Q000139:chemically induced
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D013723:Teratogens; D008727:Methotrexate