In utero medroxyprogesterone exposure after contraceptive failure.

The authors describe a case in which injectable medroxyprogesterone failed to prevent conception and then briefly review the literature on in utero exposure to medroxyprogesterone. A 20-year-old woman presented 6 weeks after the delivery of her first child for a routine examination and expressed interest in receiving medroxyprogesterone injections. She had no contraindication to her use of such hormonal contraception. As instructed, the patient returned at the beginning of her menses and was given a 150 mg injection of medroxyprogesterone. She returned 86 days later without complication and was given her next injection. Concerned after 2 weeks that she had not menstruated, the woman underwent an over-the-counter urine pregnancy test which yielded positive results. Examination identified a fetus of age 10 weeks, indicating that conception occurred 45-50 days after the initial injection. The patient gave birth to a 3720 g male infant at 39 weeks gestation, normal upon neonatal examination. The young woman subsequently had a tubal ligation. This case was reported to the Upjohn Company, but lacking the lot number of the Depo-Provera injected, the company was unable to check for additional failures with that lot. While no study has proven any significant long-term side effects associated with in utero exposure to injectable medroxyprogesterone, the drug should nonetheless remain in category X.