Enrique Donoso S

Edad materna avanzada y riesgo reproductivo

Background: Pregnancy at extreme ages is a risk factor for maternal, perinatal and infantile death. Aim: To assess the obstetric risk of women over 40 years old. Material and methods: The risk of maternal, late fetal, neonatal and infantile deaths and the risk of low birth weight was assessed in women over 40 years old and compared to the risk of women aged 20-34 years. Data was obtained from the 1999 Annual Report of the National Statistics Institute and the odds ratios (OR) with a 95% confidence interval were calculated. Results: Women over 40 years had a higher risk of maternal death (OR 7.13, 3.31-14.97), late fetal death (OR 2.19, 1.69-2.85), neonatal death (OR 1.8, 1.4-2.32), infantile death (OR 1.8, 1.49-2.18) and low birth weight (OR 1.72, 1.58-1.88). Conclusions: The higher reproductive risk of women over 40 years is confirmed. Better birth control programs at this age will reduce this risk (Rev Med Chile 2003; 131: 55-59)

REDUCCIÓN DE LA MORTALIDAD POR CÁNCER CÉRVICO UTERINO EN CHILE, 1990-2003

SUMMARY Objective: To analyze the effect of the National Program for Cervical Cancer on the mortality trend due to this cancer in Chile during 1990-2003, and the feasibility to achieve a 40% reduction in mortality rate at the year 2010. Methods: The number of deaths due to cervical cancer, the age interval of the deceased women, and the estimate of women population were obtained from the Year Book edited by the National Institute of Statistics of Chile. The gross and age-adjusted mortality rates were calculated using year 2003 as a standard of population number. The trend and the slope for the period, and the estimated number of deaths at year 2010 were calculated using linear regression. Results: A significant descending trend for the adjusted death rate was observed when comparing years 1990 and 2003 (from 14.3/100,000 in 1990 to 8.5/ 100,000 in 2003, r=‐0.977; p<0.001). The slope for the period showed a yearly reduction in rate of 0.463/ 100,000 women, estimating for year 2010 a mortality rate about 4.8/100,000 women, lower than the objective proposed by the Public Health Ministry of Chile. Conclusions: The introduction of a National Program for Cervical Cancer has allowed reducing significantly the mortality rate due to this cancer between

Desigualdad en mortalidad infantil entre las comunas de la provincia de Santiago

Background: Social and economical inequalities have an adverse effect on infant mortality. Aim: To test if the poorest communities of Santiago have the highest rates of infant mortalilty. Material and methods: Variables were obtained from the year 2000 Vital Statistics yearbook and the National Socioeconomic Characterization inquiry. Infant mortality was correlated with the mean income of households, the population below the threshold of poverty and the unemployed population of the 32 municipalities of the Santiago Province. The ratio and the difference in mortality rates between the communities with the higher and lower incomes and the attributable population risk for infant mortality in the Province of Santiago was calculated. Results: Infant mortality was positively correlated with the population below the threshold of poverty (r=0.383; p=0.03) and the unemployed population (r=0.437; p=0.012) and inversely correlated with the mean household income (r=-0.522; p=0.002). Infant mortality in the poorest community was 2.2 times higher than in the richest one. The difference in rates was 6.6/1000 live births. The attributable population risk determined that it is possible to reduce infant death by 57.8%. Conclusions: In the Province of Santiago, the poorest communities have the highest infant mortality (Rev Med Chile 2004; 132: 461-6)

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 9.9/100000 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.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.

MORTALIDAD MATERNA EN CHILE, 2000-2004

Antecedentes: La mortalidad materna es un problema importante de salud publica, especialmente en los paises menos desarrollados. Objetivo: Vigilancia epidemiologica de la mortalidad materna en el periodo 2000-2004. Metodo: Estudio de tendencia de la mortalidad materna segun analisis de correlacion de Pearson. El numero de muertes maternas, recien nacidos vivos, edad de las fallecidas y causas de muertes, se extraen de los Anuarios de Estadisticas Vitales. Resultados: En el periodo estudiado la mortalidad materna no presento cambios significativos (r=-0,479; p=0,414). La tasa promedio de mortalidad materna fue 17,4/100.000 nacidos vivos. Las primeras 5 causas de muerte materna fueron: sindrome hipertensivo del embarazo (25%), enfermedades maternas concurrentes (20,2%), aborto (12,0%), embolia obstetrica (5,3%) y sepsis puerperal (4,8%). En el periodo, la natalidad descendio significativamente (r=-0,993; p=0,001), y no se correlaciono con la mortalidad materna (r=+0,424; p=0,477). La natalidad en mujeres de 35 a 39 anos no presento cambios significativos (r=-0,503; p=0,387), en las ≥40 anos fue significativamente ascendente (r=+0,984; p=0,002), mientras que en las de 20 a 34 anos hubo una reduccion significativa (r=-0,995; p<0,001). Conclusiones: La mortalidad materna en Chile no se modifico en los ultimos 5 anos. La tendencia de la natalidad segun grupos etarios muestra que la poblacion chilena concentra un mayor riesgo obstetrico, con un aumento de la mortalidad materna por enfermedades concurrentes. El Ministerio de Salud de Chile debe reformular las estrategias para continuar con la reduccion de la mortalidad materna

MORTALIDAD POR CÁNCER EN LA MUJER CHILENA: ANÁLISIS COMPARATIVO ENTRE LOS AÑOS 1997 y 2003

SUMMARY Background: Cancer is the second cause of death in developed countries and shows a continuous reduction in rate independently of sex and race. Objectives: To compare the cancer mortality rate observed among Chilean women and establishing the main localizations causing death in that group in 1997 and 2003. Material and Methods: The cancer mortality rate was calculated using the total number of cancer deaths and the estimated women population obtained from the vital statistical reports of 1997 and 2003. Results: Between 1997 and 2003, it was a significant increase in overall cancer mortality rate among women. In both years, the five more frequent causes of cancer death were: breast, stomach, gallbladder, lung, and cervical cancer; among them, breast cancer increased and cervical cancer decreased, both significantly; the others did not experience significant rate changes. There were significant increases in other less frequent cancers such as: colon, pancreas, ovarian, non-Hodgkin lymphoma, myeloma, brain, bladder, and lymphatic leukemia. Conclusions: Overall, there has been an increase in oncologycal mortality rate in Chilean women. With the exception of cervical cancer, the majority of the more frequent cancers have increased their mortality rate. This increasing mortality trend enforces to review the quality of the data registration, the existing health programs, and designing new strategies which will lead us to improve prevention, access, and quality of treatment, and finally to decrease cancer mortality. New strategies such that incorporated in Law 19,996 are called to change current outcomes.

ANÁLISIS COMPARATIVO DE LA MORTALIDAD MATERNA EN CHILE, CUBA Y ESTADOS UNIDOS DE NORTEAMÉRICA

En 2000, la mortalidad materna en Chile, Cuba y EEUU, fue de 18,7/100.000, 40,4/100.000 y 9,8/100.000 nacidos vivos respectivamente, diferencias estadisticamente significativas. La tasa de mortalidad materna por causas directas en Chile fue significativamente menor que en Cuba y mayor que en EEUU; mientras que la por causas indirectas no presento diferencias significativas con Cuba y fue significativamente mayor que en EEUU. La tasa de muerte materna por aborto en Chile, Cuba y EEUU fue de 4,6/100.000, 2,8/100.000 y 0,3/100.000 nacidos vivos respectivamente, diferencias explicadas por el aborto legalizado. Chile fue el unico de los tres paises que redujo la mortalidad materna en mas de 50% entre 1990-2000

Reducción de la fecundidad y envejecimiento de la población de mujeres chilenas en edad fértil: 1990-2004

BACKGROUND Chile is in the advanced stage of demographic transition with a low natural growth and a progressively aging population. AIM To analyze births by range of maternal age and to establish if population aging is expressed in the womens fertile age range. MATERIAL AND METHODS Trend analysis of births and age-specific birth rates in the period 1990-2004, in the Chilean women population of reproductive age. Raw data were obtained from the Vital Statistics Yearbooks of the National Institute of Statistics. Trends were studied by linear regression and Generalized Estimating Equation (GEE). RESULTS The general trend of births descended significantly from 1999 to 2004 (r: -0.996; p <0.001). Births significantly decreased in the range of ages from 20 to 34 years. There was an increase in the range of ages from 35 to 44 and from 10 to 14 years. The age-specific birth rate declined in all ranges, with the exception of women aged 10 to 14 years. The number of women increased significantly at all age ranges, except for the 20-24 year-old range where no significant change was observed and the 25-29 year-old range that experienced a significant reduction. CONCLUSIONS In the period from 1990 to 2004, there was a significant reduction of births and age-specific birth rates in Chile. There was also an increased birth rate among women aged 35 to 44 years and an aging of the fertile women population.

PLAN DE ACCION REGIONAL PARA LA REDUCCION DE LA MORTALIDAD MATERNA EN LAS AMERICAS: RESULTADOS DE CHILE

Chile, en el periodo 1990-2000, redujo la mortalidad materna en 53,1%, con una tasa para el ano 2000 de 18,7/100.000 nacidos vivos, cumpliendo con el Plan de Accion Regional para la Reduccion de la Mortalidad en las Americas. Los factores mas importantes fueron la atencion profesional de casi la totalidad de los partos (99%), el descenso de la natalidad (-14,8%) y de la mortalidad materna por aborto (-40%), hipertension arterial (-42,3%) y sepsis puerperal (-91,8%). No hubo reduccion de la mortalidad materna por enfermedades pregestacionales

TROMBOSIS DE LA VENA OVARICA DERECHA POSTPARTO VAGINAL

RESUMENSe presenta un caso clinico de trombosis de la vena ovarica derecha postparto vaginal. Se analizan losmetodos de diagnostico por imagenes, el diagnostico diferencial, el tratamiento y la tromboprofilaxis en unafutura gestacion.PALABRAS CLAVES: Trombosis de la vena ovarica, tratamiento anticoagulante trombofiliasSUMMARYA case report of right ovarian vein thrombosis after vaginal delivery is presented. Its analyse includingdiagnostic methods by images, the differential diagnosis, the therapy and the thromboprophylaxis for afuture gestation.KEY WORDS: Ovarian vein thrombosis, anticoagulant therapy, thrombofilias Casos Clinicos *Trabajo recibido en septiembre de 2002 y aceptado para publicacion por el Comite Editor en octubre de 2002. INTRODUCCIONLa trombosis de las venas ovaricas es unacomplicacion grave del puerperio y potencial-mente fatal. Su incidencia es de 1 por 596 a 2.019partos y generalmente compromete la venaovarica derecha (1, 2, 3). Previo al desarrollo delos metodos diagnosticos no invasivos, muchaspacientes eran intervenidas con el diagnostico deapendicitis aguda. Actualmente, los metodos dediagnostico por imagenes (4), tales como laultrasonografia, la tomografia axial computada y laresonancia nuclear magnetica, evitan laparoto-mias innecesarias y permiten iniciar un efectivotratamiento basado en la anticoagulacion y losantibioticos. A continuacion se presenta un casoclinico de trombosis de la vena ovarica derechapostparto vaginal, con el enfrentamiento diagnos-tico y terapeutico actual.CASO CLINICOPaciente de 32 anos, multipara de 2 partosvaginales, sin antecedentes morbidos de importan-cia y con embarazo de evolucion fisiologica. Exa-menes de laboratorio en rangos de normalidad.Cultivo vaginal negativo para Estreptococo grupo B.Ingresa en trabajo de parto con 3 cm de dilataciona las 6:00 horas del 17 de enero del 2002. Seefectuo rotura artificial de las membranas ovularesa las 8:35 horas, con 8 cm de dilatacion. Una horamas tarde se asiste parto vaginal espontaneo derecien nacido masculino de 3.895 gramos, Apgar 9a los 5 minutos de vida. El alumbramiento fue es-pontaneo con revision instrumental de la cavidaduterina. A las 36 horas postparto, presento alzatermica de 39,5° C que se controla con 500 mg deacetamifeno. Dada de alta a las 48 horas postparto,asintomatica y con examen fisico normal. En la