Methotrexate??

I just wanted general opinions on methotrexate and what your stance is on giving it. I had a situation where I work that my patient had been trying to conceive for 12 years. Finally did naturally only to be told she had an ectopic at 7 weeks. I get in for my shift and am advised by OB doc to give her methotrexate to terminate the pregnancy. Fast-forward 2 weeks and the patient comes back in with spotting. Pt tells me after a few days she had not passed anything, went back to her doc and turns out it was a viable pregnancy with a heartbeat and it was not actually an ectopic. She gets an ultrasound this second night she comes in and we find out she is now miscarrying. I can't help but feel a little guilty that I gave the medication. I know I was given an order by the doc to do it, but they were wrong and now I'm hesitant if I have to give it again. What are your opinions???

First, if I were that patient, I would be devastated. That being said, it was the doctor who misdiagnosed, not you. You were following orders, and there is no way that you could have interceded. It was not a medication dosage error that you could have caught and corrected. I'm sorry. I would feel very sad for the patient, but not guilty. The doctor, on the other hand...

Maybe sorry is the right word. I know there was nothing I could have done given that was the order I was given. She was very much devastated and I had to give her bad news twice. I felt awful. I had a missed miscarriage in May so I know how it feels to have a loss. I just feel like now I'm going to question whether or not I should give it in the future

It can save a woman's life and fertility. I feel very bad for that woman, but you would have no way to know she was misdiagnosed.

I feel so bad for the pt and for you. That would be one of the most difficult situations to be in. However, you did nothing wrong and there was really nothing else you could have done. Do not beat yourself up over this.

I'm very sorry for your loss, too.

As far as giving it in the future, I don't know how you could not give it without legal/employer repurcussions. What would you say? "No, I can't follow doctor's orders because Dr. X misdiagnosed and it may happen again?" I honestly don't know. Maybe leave OBGYN, but if it is your passion?

It shows your heart to feel for your patients' losses...but as the others have said, you didn't do anything wrong, and methotrexate has a lot of uses that save lives (I'm on it now for a year for leukemia). The good outweighs the bad, and all meds carry risks, but we have to give them because the likelihood of something bad happening is small enough to use them.

I feel for you and your patient but i honestly think you should delete this post. It's too specific and it could come up on a search, especially if she is pursuing her legal options.

There's only one person in the US who could fit this criteria sometime in the last few years???