Treating patients with severe preeclampsia and eclampsia in Oaxaca, Mexico.

de vacunación incompleto. Al hacer referencia al cumplimiento de los objetivos en el trabajo cuestionado, así como al apego a los criterios de Strengthening the Reporting of Observational Studies in Epidemiology (Strobe) que tuvieron los autores, en la Respuesta de la autora se afirma que " […] los estudios observacionales pueden realizarse con el propósito de describir la magnitud y distribu-To the editor: The Mexican state of Oaxaca continues to be marked by dramatic maternal mortality rates (MMR). In 2009, it had the second-highest MMR with 98.3 maternal deaths per 100 000 live births, compared to the national average of 62.2. 1 Almost one-fourth of these deaths were due to hypertensive disorders during pregnancy. 1 One such disorder , preeclampsia, is characterized by high blood pressure and excess protein in the urine, usually during the second half of gestation, and is 'severe' when manifested with extreme hypertension, heavy proteinuria or substantial maternal organ dys-function. If not managed properly, severe preeclampsia can progress to eclampsia, triggering convulsions. 2 The Mexican Ministry of Health (MOH)'s technical guidelines list magnesium sulfate (MS) as the drug of choice to prevent and treat convulsions ; only when MS is unavailable do they recommend other antihyper-tensive drugs like phenytoin or phe-nobarbital. Furthermore, termination of the pregnancy or delivery of the fetus and placenta within six hours of diagnosis is strongly advised. 3 Prior studies in Mexico have suggested , however, that providers often do not treat according to technical guidelines, using MS inconsistently or not at all. The purpose of this letter is to document the treatment of women with preeclampsia and eclampsia in MOH hospitals in Oaxaca, identify barriers to optimal treatment, and develop recommendations for improved practice through a series of studies. We used a combination of quantitative and qualitative methods for our research. For our quantitative analyses , we reviewed medical records of women diagnosed with severe preeclampsia and eclampsia in 2008 across eight general MOH hospitals and one community-based facility. That year, there were 23 300 obstetric events archived, 6 493 of which had complete records and were reported as cases with severe preeclampsia and eclampsia. To gauge usage of antihypertensive and anticonvulsant