[Acute toxicity by methotrexate used for abortion purpose. Case report]

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.

[Prevalence of illegal abortions in Libreville Hospital, Gabon]

The objectives of this study were to determine the prevalence of illegal abortion in Libreville and to describe abortive methods used. It is a cross sectional and descriptive survey carried out at the maternity hospital of Libreville (MHL) during one year, from 1 January 2008 to 31 December 2008. 750 abortions were performed during this period and 651 cases were illegal abortions. Prevalence was of 86.7%. The women undergoing illegal abortion were most often pupils (67.1%), with an average age of 22.4 +/- 5.3 years old and a mean parity of 1.2 +/- 1.50. The average gestational term was of 7.4 +/- 1.9 weeks. Misoprostol (63.1%) was the most frequent abortive product used. 2 maternal deaths were notified. Prevalence of illegal abortions is increasing at the MHL. Up to now, misoprostol is the most frequent abortive product used.

Herbal infusions used for induced abortion

Plants and herbs have been used to induce abortions but there is very little published information describing the commonly used ones. The purpose of this report is to describe the herbal products used to induce abortions, and to enhance awareness and understanding of their toxic effects. A descriptive retrospective survey was conducted on the calls received by the Montevideo Poison Centre between 1986 and 1999 concerning the ingestion of herbal infusions with abortive intent. A total of 86 cases involving 30 different plant species were identified. The species most frequently involved were ruda (Ruta chalepensis/graveolens), cola de quirquincho (Lycopodium saururus), parsley (Petroselinum hortense), and an over-the-counter herbal product named Carachipita. The components of Carachipita are pennyroyal (Mentha pulegium), yerba de la perdiz (Margiricarpus pinnatus), oregano (Origanum vulgare), and guaycuri (Statice brasiliensis). Abortion occurred in 23 cases after the ingestion of parsley, ruda, Carachipita, celery, Cedron, francisco alvarez, floripon, espina colorada. Out of the 23 cases, 15 involved the only the ingestion of plants, 4 cases used injected drugs (presumably hormones), and in 4 cases there was associated self-inflicted instrumental manipulation. Multiple organ system failure occurred in those patients who had ingested ruda (alone or in combination with parsley or fennel), Carachipita, arnica, or bardana. Deaths occurred in one case of Carachipita ingestion and in 4 cases of ruda ingestion (2 cases of ruda alone, 2 cases of ruda with parsley and fennel). Self-inflicted instrumental manipulations were found in 4 of the patients with multiple organ system failure and in one of those who died. The results of this report are not conclusive, but it appears that the ingestion of plants to induce abortion involves the risk of severe morbidity and mortality.

Abortifacients: toxidromes, ancient to modern--a case series and review of the literature

Between 1998 and 1999, four women presented to an emergency department after having attempted a nonmedical abortion. All four reported turning to pharmacologically induced abortion because their access to health care was limited by lack of insurance and resources. These cases serve as a reminder that self-induced abortion remains a significant health problem for women, a problem that emergency physicians as toxicologists should be aware of.

Ponderosa pine and broom snakeweed: poisonous plants that affect livestock

Ponderosa pine (Pinus ponderosa) and the snakeweeds (Gutierrezia sarothrae and G. microcephala) are two groups of range plants that are poisonous to livestock. Ponderosa pine causes late-term abortions in cattle, and the snakeweeds are toxic and also cause abortions in cattle, sheep, and goats. Research is underway at the USDA-ARS-Poisonous Plants Research Laboratory to better understand livestock poisonings caused by grazing ponderosa pine needles and the snakeweeds and to provide methods of reducing losses to the livestock and supporting industries. This review includes the history of the problem, a brief description of the signs of poisoning, the research, to identify the chemical toxins, and current management practices on prevention of poisonings.

Toxic ingestions in pregnancy: abortifacient use in a case series of pregnant overdose patients

OBJECTIVES

To profile young, pregnant patients with an overdose reported to an urban poison center; and to characterize the ingestions and short-term outcomes of these overdose patients.

METHODS

A prospective, observational study of female overdose patients was performed from November 1, 1994, through March 31, 1995. Consecutive cases were identified from all calls to the regional poison center (annual call volume = 70,000) regarding intentional overdose in women between the ages of 12 and 30 years. Pregnancy tests were recommended by the poison center during the study period in female patients aged 12-30 years who presented to a health care facility (usually an urban ED) with an intentional overdose. Pregnant patients were then followed during their hospitalizations, and the results of toxicology studies and maternal and short-term fetal outcomes were recorded.

RESULTS

Pregnancy tests were obtained for 371 (32%) of 1,142 eligible patients. Of patients with pregnancy tests, 43 (11.6%) were pregnant. Although most cases were comparable to general adult intentional ingestions, 5 of the 43 pregnant patients ingested known abortifacients. Most pregnant patients (35/43, 81%) had toxicity at or below American Association of Poison Control Centers (AAPCC) criteria for minimal toxicity, and all patients recovered completely.

CONCLUSION

Pregnancy was a common finding in this sample of young, female, intentional overdose patients reported to our regional poison control center. Frequent use of abortifacients for toxic ingestions has not been previously reported. A pregnancy test should be obtained for all female patients of childbearing age with an intentional ingestion to address the potential association of the ingestion with an unanticipated or undesired pregnancy.