title: [TOLUCA experience in preeclampsia-eclampsia].
abstract: BACKGROUND
  Reducing morbidity and mortality due to preeclampsia-eclampsia represents a challenge in health care. Since 1997, in the city of Toluca, Estado de México, a research unit was implemented along with a national expert committee for the study of preeclampsia-eclampsia. This was followed by the development of an educational program and the establishment of a diagnosis and treatment protocol TOLUCA.
  
  
  METHODS
  We reviewed the mortality registered in the obstetric ICU of our institute, before and after the implementation of the TOLUCA protocol and including a review of the impact of human resources obtained from our educational program, clinical research and the establishment of a research unit.
  
  
  RESULTS
  During a period of 12 years, 1723 patients were treated, with 102 (5.9%) maternal deaths. Preeclampsia-eclampsia accounted for 49 (48%), obstetric hemorrhage 29 (28%), sepsis 9 (9%) and miscellaneous 15 (15%) of all deaths. Data were chronologically divided from 1992 to 1996 (group A) and from 1997 to 2003 (group B), before and after the implementation of the TOLUCA protocol. Group A included 289 admissions with 39 deceased representing a relative mortality of 13.4% (1 death per 7 admissions). Group B included 1434 admissions with 63 deaths, representing a relative mortality of 4.3% (1/23 admissions). Twenty obstetrician/gynecologists were graduates in clinical medicine, 25 research papers were published, four books on preeclampsia were published including preeclampsia, critical medicine, arterial hypertension and renal failure, six book chapters, and the physical implementation of a research unit with laboratory, physician's office and surgical facility.
  
  
  CONCLUSIONS
  Results obtained using the TOLUCA protocol allow us to propose it as a prototype for application in obstetric-gynecology hospitals in order to improve medical care by establishing a high-level of care with on-going research.
authors.affiliation: Instituto Materno-Infantil del Estado de México, Mexico.
authors.forename: Jesús Carlos
authors.initials: JC
authors.lastname: Briones-Garduño
authors.forename: Enrique
authors.initials: E
authors.lastname: Gómez-Bravo Topete
authors.forename: Fernando
authors.initials: F
authors.lastname: Avila-Esquivel
authors.forename: Manuel
authors.initials: M
authors.lastname: Díaz de León-Ponce
mesh_terms: D000328:Adult; D003627:Data Interpretation, Statistical; D004461:Eclampsia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008428:Maternal Mortality / Q000639:trends*; D008800:Mexico; D011225:Pre-Eclampsia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D011247:Pregnancy; D011787:Quality of Health Care; D012106:Research