A group of medical researchers in the U.S. and Canada have collected data on the catastrophic consequences of using methotrexate for pregnancies misdiagnosed as ectopic.
The reasearchers concluded, based on the always dire outcomes, and frequent misdiagnosis, up to (40-50% in the ER), of ectopic pregnancy, that a non-judgmental system to allow further collection data on errors in the use of methotrexate needs to be collected. Fear of reprisal severely inhibits the reporting of these cases.
Ectopic pregnancy, occurring when the embryo develops outside the uterus, is often treated by salpingectomy (removal of the embryo and fallopian tube), salpingotomy (less drastic), or the use of methotrexate to cause demise of the embryo, and resorption. Use of this drug has increased drastically in the last 10 years as a means to preserve fertility for the mother. Controversy surrounds the treatment for those who view it as a direct and specific attack on the developing human, or for those who cite the probability of incorrect use. Diagnostic emphasis in recent years seems more geared towards avoiding missed cases of ectopic pregnancy, rather than being most certain that the pregnancy is actually located outside of the uterus.
The authors argued that ectopic pregnancy should be substantiated by a confirmatory ultrasound, and methotrexate used only after careful consideration. They cited the alway disastrous results of misapplied methotrexate treatment, including deaths of otherwise healthy unborn babies, or babies born with severe skeletal and cardiac defects.
Does this mean that stat orders for methotrexate from emergency departments, and orders of this drug for “possible ectopic pregnancy” should cease altogether?
That's crazy and scary that a drug would be prescribed when it has such potential for harm, without first confirming an ectopic pregnancy through ultrasound.
The ER is a dicey place, that's for sure.