Outcome following high-dose methotrexate in pregnancies misdiagnosed as ectopic

Nurmohamed, Laila; Moretti, Myla E; Schechter, Tal; Einarson, Adrienne; Johnson, Diana; Lavigne, Sharon Voyer; Erebara, Aida; Koren, Gideon; Finkelstein, Yaron

doi:10.1016/j.ajog.2011.07.002

Cited by 54 publications

(38 citation statements)

References 17 publications

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“…The largest observational study by our group included eight pregnant women who were misdiagnosed as an ectopic pregnancy and treated with 50-184 mg MTX. None of these pregnancies resulted in the birth of healthy newborn (two newborns had major malformations compatible with MTX embryopathy (one of them had a stillbirth at 30 gestational weeks), three of eight pregnancies resulted in spontaneous miscarriage less than 2 weeks after MTX treatment, and three of eight women terminated the pregnancy based on their physician advice) [1]. Overall, the risk of this patient having a baby with birth defects is substantially increased when compared to the population baseline of 1-3 % [4].…”

Section: Diagnosis and Assessmentmentioning

confidence: 97%

“…Different regimens of delivering high-dose MTX (60-100 mg or more) to a patient with ectopic pregnancy have been described [1]. Typically, misdiagnosed intrauterine pregnancy which is treated as ectopic pregnancy exposes the fetus to high-dose MTX during critical stages of embryogenesis.…”

Section: Diagnosis and Assessmentmentioning

confidence: 99%

“…MTX, a folic acid antagonist and DNA synthesis inhibitor in rapidly dividing cells, has been implicated in as a human teratogen, particularly when used in a high dose during the first trimester of pregnancy. MTX embryopathy (the aminopterin syndrome) is characterized by intrauterine growth restriction, miscarriage, stillbirth, cardiac defects, dysmorphic facial features, neural tube and skeletal anomalies, and mental retardation [1,2] (Table 10.1).…”

Section: Diagnosis and Assessmentmentioning

confidence: 99%

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Effect of Methotrexate Treatment for Ectopic Pregnancy on Current and Subsequent Pregnancy

Namouz-Haddad

Koren

2015

Ectopic Pregnancy

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A 30-year-old woman was referred to a high-risk clinic, to discuss the consequences of 80 mg intramuscular (IM) methotrexate (MTX) given due to an erroneous diagnosis of ectopic pregnancy at 6 weeks' gestation of a planned pregnancy.Two days prior to her referral, a transvaginal ultrasound examination revealed a viable intrauterine pregnancy, 8.3 gestational weeks based on crown-rump length (CRL) measurement of 18.9 mm with a positive and normal fetal heartbeat, with no abnormal findings on adnexas (Fig. 10.1).The couple was very concerned about the risks of an adverse pregnancy outcome in the current and subsequent pregnancies due to MTX treatment.

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Section: Diagnosis and Assessmentmentioning

confidence: 97%

Section: Diagnosis and Assessmentmentioning

confidence: 99%

Section: Diagnosis and Assessmentmentioning

confidence: 99%

See 1 more Smart Citation

Effect of Methotrexate Treatment for Ectopic Pregnancy on Current and Subsequent Pregnancy

Namouz-Haddad

Koren

2015

Ectopic Pregnancy

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“…A longer evaluation time can delay the treatment of an ectopic pregnancy increasing risk of rupture, potentially leading to dangerous hemorrhage, compromised fertility, and increased mortality [2, 3, 12]. However, presumptive treatment may lead to misdiagnosis, inappropriate treatment, and adverse events related to treatment (and not the underlying condition) including embryo toxicity and teratogenicity [13, 14]. Given recent literature that supports the use of uterine curettage prior to administration of methotrexate in a nonviable PUL, it is important to assess how much of this evidence is translating into practice patterns of Obstetricians and Gynecologists in the United States.…”

Section: Discussionmentioning

confidence: 99%

Trends in the Management of Nonviable Pregnancies of Unknown Location in the United States

Parks

Barnhart

Howard

2018

Gynecol Obstet Invest

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Background: When managing a nonviable pregnancy of unknown location (PUL), a debate has emerged in the literature whether to perform uterine curettage for definitive diagnosis of pregnancy location or administer methotrexate for a presumed ectopic pregnancy. The purpose of this study is to describe the treatment patterns when managing a PUL. Methods: A prospective, anonymous Internet based-electronic survey of PUL case scenarios was administered to a random sample of physicians across the United States. Results: A total of 214 physicians responded. When presented with a PUL by ultrasound and a βhCG measurement of 3,270 mIU/mL, which is above the discriminatory level, 88.3% (188) would choose an additional βhCG measurement before recommending any intervention. When presented with a PUL by ultrasound and serial βhCG measurements demonstrating an inappropriate trend for a viable gestation, 36.5% would offer uterine curettage and 31.3% would offer methotrexate. Resident and private clinicians had a fourfold lower adjusted odds of choosing uterine curettage compared to academic physicians. Conclusions: Based on our findings, there does not appear to be a consensus regarding the management of a PUL.

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“…A administração durante o segundo e terceiro trimestres aumenta o risco de restrição de crescimento intrauterino e de baixo peso ao nascimento. [87][88][89] A taxa de abortamento durante o tratamento com metotrexato é de aproximadamente 40%, consideravelmente mais elevada do que a observada na população em geral ou mesmo em doentes com doenças autoimunes. 90 Um intervalo mínimo de um a três meses entre a interrupção do metotrexato e a conceção é recomendado.…”

Section: Espironolactona (Categoria De Risco C Pela Fda)unclassified

Gravidez, Aleitamento e Fármacos em Dermatologia - Tratamento Sistémico

Cesar

Azevedo

Mota

2016

SPDV

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RESUMO -O crescente número de fármacos empregues na prática dermatológica e venereológica exige do dermatologista um conhecimento atualizado relativo à sua segurança. No caso particular de mulheres grávidas ou que amamentem, a decisão sobre se se deve ou não tratar com um determinado fármaco deve basear-se numa avaliação ponderada dos benefícios para a saúde materna e dos riscos potenciais para o bem-estar fetal ou do lactente. Quando estas doentes necessitam terapêuticas tópicas ou sistémicas, a maioria pode ser adequadamente tratada com opções consideradas seguras e eficazes. Na primeira parte deste artigo são abordados os dados mais recentes relativos à segurança de alguns dos medicamentos sisté-micos mais comummente usados em contexto dermatológico, na mulher em idade fértil. PALAVRAS-CHAVE -Agentes Dermatológicos/uso terapêutico; Aleitamento/efeito dos medicamentos; Complicações na Gravidez/quimioterapia; Doenças da Pele/quimioterapia; Doenças de Pele/tratamento; Gravidez. Pregnancy, Lactation and Drugs in DermatologySystemic Therapy ABSTRACT -The increasing number of drugs used in dermatological a venereological practice demands from the dermatologist INTRODUÇÃOAo tratar doentes grávidas ou durante o período de aleitamento é fundamental um conhecimento dos potenciais efeitos adversos dos medicamentos sobre o desenvolvimento do feto ou do lactente. O risco de teratogenicidade e a capacidade de cada fármaco ser excretado no leite materno permite, na maioria das ocasiões, optar por alternativas seguras no tratamento de doenças do foro dermatológico em mulheres durante o período gestacional e durante a amamentação.Este artigo de revisão tem por objetivo abordar os dados disponíveis referentes à segurança (ou falta dela) de alguns dos fármacos mais comummente prescritos em contexto dermatológico e venereológico nas mulheres em idade fér-til. A primeira parte deste artigo aborda os fármacos administrados por via sistémica e a segunda parte irá abordar os fármacos de aplicação local. Corticosteróides sistémicos (categoria de risco C pela Food Drug Administration -FDA)A dexametasona e a betametasona não sofrem metabolização placentária significativa, passando inalterados através da placenta.1 Já a prednisolona sofre conversão em metabolitos inativos pela placenta humana, o que limita a sua passagem para o embrião/feto, pelo que é a opção

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Outcome following high-dose methotrexate in pregnancies misdiagnosed as ectopic

Cited by 54 publications

References 17 publications

Effect of Methotrexate Treatment for Ectopic Pregnancy on Current and Subsequent Pregnancy

Effect of Methotrexate Treatment for Ectopic Pregnancy on Current and Subsequent Pregnancy

Trends in the Management of Nonviable Pregnancies of Unknown Location in the United States

Gravidez, Aleitamento e Fármacos em Dermatologia - Tratamento Sistémico

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