Medicolegal Review of Methotrexate Administration to Viable Intrauterine Pregnancies

OBJECTIVE: To examine 3 legal cases in which physicians prescribed methotrexate to women with a viable intrauterine pregnancy, presumed to be ectopic, resulting in adverse fetal outcomes. STUDY DESIGN: We conducted an electronic literature search for legal cases using the keywords "methotrexate" and "pregnancy" in the LexisNexis legal research engine as well as an Internet wide search using the additional keyword "verdict." We manually searched the resultant list of identified cases and categorized the studies identified in the search by verdict, award amount, and outcome of the embryo exposed to methotrexate. RESULTS: The monetary awards are typically greater when the embryo exposed to methotrexate lives and requires continuous medical and custodial care as compared to when the fetus dies in utero or shortly after birth. CONCLUSION: Physicians who, with all good intentions, prescribe methotrexate to women with a viable pregnancy, presumed to be ectopic, could find themselves liable for an adverse fetal outcome. For the benefit of patients, their unborn offspring, and the liability ex-posure of the physician, it is important to be very cautious when prescribing methotrexate.