El cambio del perfil epidemiológico de la mortalidad materna en Chile dificultará el cumplimiento del 5° objetivo del Milenio / The change in the epidemiological profile of maternal mortality in Chile will hinder the fulfillment of the Millennium 5th goal

Background: The death of women during pregnancy, childbirth or puerperium, remains a serious public health problem worldwide. Chile is committed to comply with the Millennium 5th Goal of reducing maternal mortality to 9.9/100,000 live births in 2015. Aim: To analyze trends in maternal mortality in Chile during 2000-2009. Material and Methods: A descriptive population analysis using raw data obtained from the yearbooks of the National Institute of Statistics of Chile. Maternal mortality, causes of death and age of the dead mothers were evaluated. The causes of maternal death were classified according to the tenth revision of International Classification of Diseases. Trend studies were performed using Pearson correlation analysis. Results: In the studied period there were no significant changes in maternal mortality and fertility. The five major causes of maternal death were concurrent diseases, hypertension, abortion, obstetric embolism and postpartum hemorrhage. Mortality associated with concurrent illness showed a significant upward trend (r = 0.656, p = 0.035). Abortion associated mortality had a significant downward trend (r = -0.712, p = 0.023). The group of women 40 years and older significantly increased its birth rate (r = 0.930, p < 0.001), this group showed the highest maternal mortality, especially in association with concurrent diseases. Conclusions: The increased birth rate occurring in women over 40 years old and its larger maternal mortality rate, probably will hinder the fulfillment of the Millennium 5th goal in Chile.

El aborto eugenésico podría explicar la menor mortalidad infantil existente en Cuba comparada con la de Chile / Eugenic abortion could explain the lower infant mortality in Cuba compared to that in Chile

Background: Cuba and Chile have the lower infant mortality rates of Latin America. Infant mortality rate in Cuba is similar to that of developed countries. Chilean infant mortality rate is slightly higher than that of Cuba. Aim: To investigate if the lower infant mortality rate in Cuba, compared to Chile, could be explained by eugenic abortion, considering that abortion is legal in Cuba but not in Chile. Material and Methods: We compared total and congenital abnormalities related infant mortality in Cuba and Chile during 2008, based on vital statistics of both countries. Results: In 2008, infant mortality rates in Chile were significantly higher than those of Cuba (7.8 vs. 4.7per 1,000 live born respectively, odds ratio (OR) 1.67; 95% confidence intervals (Cl) 1.52-1.83). Congenital abnormalities accounted for 33.8 and 19.2% of infant deaths in Chile and Cuba, respectively. Discarding infant deaths related to congenital abnormalities, infant mortality rate continued to be higher in Chile than in Cuba (5.19 vs. 3.82 per 1000 live born respectively, OR 1.36; 95%CI 1.221.52). Conclusions: Considering that antenatal diagnosis is widely available in both countries, but abortion is legal in Cuba but not in Chile, we conclude that eugenic abortion may partially explain the lower infant mortality rate observed in Cuba compared to that observed in Chile.

Embarazo en una paciente usuaria de diálisis peritoneal / Pregnancy in a peritoneal dialysis patient

El embarazo en pacientes con insuficiencia renal terminal es un evento infrecuente que se asocia a perdida fetal, prematurez y restricción de crecimiento intrauterino, además de exacerbación o aparición de patología maternal como hipertensión arterial. A continuación se presenta el caso clínico de una paciente en diálisis peritoneal ambulatoria continua que cursa un embarazo en el cual se obtiene excelentes resultados materno-perinatales. Existió un adecuado control metabólico y manejo de las cifras tensionales en la madre. Las complicaciones fetales fueron el desarrollo de polihidroamnios y prematurez (36 semanas de edad gestacional) El producto fue un recién nacido sano adecuado para la edad gestacional, sin complicaciones neonatales. De esta manera sugerimos la diálisis peritoneal como una opción válida en el manejo de pacientes embarazadas en falla renal terminal