[Criteria for birth delivery in women with severe preeclampsia in expectant management]. / Criterios de inducción del nacimiento en mujeres con preeclampsia severa en tratamiento expectante.

BACKGROUND: Preeclampsia complicates pregnancy in 3% to 8%, in Mexico it occurs in 5% to 10% of all pregnancies. The world incidence of the severe form all is unknown; however, in United States an incidence of 1% has been reported. Among the causes precipitating birth induction are intrauterine growth restriction, fetal distress and placenta abruption. OBJECTIVES: To determine maternal and fetal complications in women with severe preeclampsia who were admitted to the National Institute of Perinatology, and to establish the indications for birth induction in these women undergoing expectant management between 25 to 32 weeks of gestation. PATIENTS AND METHOD: A retrospective cohort study in which we reviewed the records of all patients diagnosed with severe preeclampsia between 2005 and 2009, and we used those records of women who had a diagnosis of severe preeclampsia at admission and who met criteria for expectant management, the data were collected in a database of art, and then analyzed the different variables in Statistical Package for the Social Sciences (SPSS). RESULTS: Of the 27 patients studied, the average weeks of gestation on admission was 29.2, 41% were nulliparous as main risk factor, 100% completed lung maturity; the average time of days of expectant management was 3.1 +/- 1.3 days (interval: one to seven days). The average gestational age at the birth induction was of 30.1 weeks (interval: 25.2 to 32.5 weeks of gestation). The main criteria for birth induction were: hypertensive crisis (44%), intrauterine growth restriction (30%), hypertensive encephalopathy and epigastric pain (19% each), elevation of transaminases and thrombocytopenia (11%), and oliguria (7%). The way of birth was 96% by caesarean and 4% by vaginal birth. CONCLUSION: The main criteria for birth induction in our sample were the uncontrolled blood pressure and intrauterine growth restriction. The time for the extension of the pregnancy was not significant compared with other studies; however, fetal lung maturity was completed.

[Acute toxicity by methotrexate used for abortion purpose. Case report]. / Intoxicación aguda por metotrexato utilizado con fines abortivos. Reporte de caso.

We report the case of a 16 years old female patient, with a pregnancy history of 11.4 weeks by ultrasound and intrauterine fetal death. In a private clinic were prescribed methotrexate 500 mg intramuscular single dose, and vaginal misoprostol. She had a clinical feature of five days of evolution characterized by fever of 39 degrees C, nausea, general attack and vomiting. The initial diagnosis was severe sepsis secondary to septic abortion, oral candidiasis and acute poisoning by methotrexate. After that, she was referred to the Instituto Nacional de Perinatologia, where stayed with fever for four days, and was managed with hydration, antibiotics, folinic acid and alkalizing. Her recovery was gradual. She was discharged after 12 days with significant clinical improvement. The literature review describes that the use of methotrexate for abortion purpose with therapeutic-dose presents a similar adverse effects to those found in our patient, however there are no case reports that describe the use of this drug in macrodosis for the same purpose, and their cytotoxic effects. We present this case because the patient used a macrodosis of this antimetabolite and due to the premature and empirical management with folinic acid, joined with alkalinization of urine, is the ideal treatment and as it is illustrated in our case.