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Failed methotrexate termination of pregnancy: a case report
1Department of Obstetrics, Gynecology and Women's Health, Jacobi Medical Center, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY 10461, USA.
Summary
Methotrexate exposure during early pregnancy can cause severe fetal abnormalities, including limb shortening and ambiguous genitalia. Improved counseling and surveillance are crucial to prevent these outcomes and reduce parental distress.
Area of Science:
- Teratology
- Developmental Biology
- Medical Genetics
Background:
- Methotrexate is a folic acid antagonist used in medical abortions.
- Exposure during the first trimester can lead to significant congenital abnormalities.
- Accurate dating and counseling are critical for managing early pregnancy interventions.
Observation:
- Antenatal ultrasound revealed intrauterine growth restriction, shortened proximal long bones, and abnormal umbilical artery Doppler.
- The patient reported methotrexate/misoprostol exposure at 6 weeks gestational age for attempted pregnancy termination.
- Newborn examination showed dysmorphic facial features, short torso, scoliosis, micropenis, and limb shortening.
Findings:
- Radiographic examination confirmed hemivertebra, rib abnormalities, absent pubic bone, and bilateral knee ossification centers.
- The observed skeletal anomalies are consistent with known teratogenic effects of methotrexate.
- The combination of findings suggests a pattern of malformation secondary to early gestational exposure.
Implications:
- This case highlights the critical need for comprehensive counseling regarding the risks of medications used in pregnancy termination.
- Enhanced prenatal surveillance is essential in cases of known or suspected exposure to teratogenic agents.
- Preventing such severe congenital anomalies can significantly reduce psychological distress for affected families.
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