title: Outcome following high-dose methotrexate in pregnancies misdiagnosed as ectopic.
abstract: OBJECTIVE
  The objective of this study was to report the outcomes of intrauterine pregnancies misdiagnosed as ectopic and exposed to methotrexate, a major teratogen.
  
  
  METHODS
  We report the outcomes of all subjects who sought consultation after exposure to high-dose methotrexate to induce abortion in presumed ectopic pregnancies, which were later identified as viable intrauterine pregnancies by 3 North American Teratology Information Services between 2002 and 2010.
  
  
  RESULTS
  Eight women with normal, desired pregnancies were administered high-dose methotrexate in the first trimester because of presumed, misdiagnosed ectopic pregnancies. All pregnancies resulted in catastrophic outcomes. Two pregnancies resulted in severely malformed newborns with methotrexate embryopathy; 3 women miscarried shortly after exposure, and in 3 the erroneous diagnosis led the physicians to advise and perform surgical termination.
  
  
  CONCLUSIONS
  Erroneous diagnosis of intrauterine pregnancies as ectopic with subsequent first-trimester exposure to methotrexate may result in the birth of severely malformed babies or fetal demise.
authors: Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
authors: Laila
authors: L
authors: Nurmohamed
authors: Myla E
authors: ME
authors: Moretti
authors: Tal
authors: T
authors: Schechter
authors: Adrienne
authors: A
authors: Einarson
authors: Diana
authors: D
authors: Johnson
authors: Sharon V
authors: SV
authors: Lavigne
authors: Aida
authors: A
authors: Erebara
authors: Gideon
authors: G
authors: Koren
authors: Yaron
authors: Y
authors: Finkelstein
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000209:etiology; D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage / Q000009:adverse effects*; D000022:Abortion, Spontaneous / Q000139:chemically induced; D000328:Adult; D003951:Diagnostic Errors; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First / Q000187:drug effects; D011271:Pregnancy, Ectopic / Q000175:diagnosis* / Q000188:drug therapy*; D013723:Teratogens; D016896:Treatment Outcome
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D013723:Teratogens; D008727:Methotrexate