Consenso salud materna para Chile en el nuevo milenio

Contexto: Chile presenta una tendencia secular hacia una sostenida mejoría en los principales indicadores materno-infantiles. Su situación constituye una experiencia positiva a nivel de la región de Latino-América y el Caribe. Sin embargo, esta tendencia se ha estancado en los últimos diez años lo que produce una situación inestable y preocupante desde el punto de vista de la salud pública materna. Esto motiva una reunión de expertos a nivel nacional e internacional para proponer estrategias para el alto nivel político orientadas a alcanzar los Objetivos 4 y 5 del Milenio. Conclusión: Este documento de consenso sobre mortalidad materna, sugiere un enfrentamiento en dos ejes: primero, enfrentar la nueva realidad epidemiológica desde la etapa pre-concepcional, esto incluye considerar la alta prevalencia de obesidad, hipertensión arterial, diabetes, hiperlipidemias e hipotiroidismo en la población, y por otro lado reforzar la seguridad de la asistencia del embarazo, parto y puerperio en los lugares más alejados y más vulnerables del país. Es necesario focalizar las intervenciones en los grupos de mayor riesgo vital (edades extremas de la vida fértil y portadoras de enfermedades médico-quirúrgicas severas, que se reflejan en el aumento proporcional de las causas indirectas de muerte materna), reforzar las actividades de auditorías de mortalidad/near miss, así como controlar el aumento alarmante de la tasa de partos por cesáreas

DIAGNOSTICO PRENATAL DE SITUS INVERSUS TOTALIS

Se presenta un caso clínico de diagnostico prenatal por ultrasonografía de Situs Inversus completo en la Unidad de ultrasonografía del Hospital San Juan de Dios con su confirmación post natal por radiología y ultrasonografía. Es de notar la baja incidencia de esta patología y la importancia del diagnostico prenatal por las posibles múltiples malformaciones asociadas.We have reviewed a clinical history of ultrasonographic prenatal diagnosis of Complete Situs Inversus at the Ultrasonography Unit of the Hospital San Juan de Dios, which was confirmed with postnatal radiology and ultrasonography. Although the low incidence of this pathology, it´s prenatal diagnosis is important since it presents association with multiple abnormalities

A Modified biophysical profile

The biophysical profile (BP) is a diagnostic method of the fetal surveillance of excellent sensibility and especificity. We introduce a modification of the scoring in which we replace the NST for two `bonus point' to fetus which reach the four ecographic criteria before 20 minutes of test. We studied 143 modified BP of 71 fetus of high risk pregnancy, the modified PB has realized in the week before delivery. 95% had score 8 or 10, 5% had 4 or 6 points, the fetus with low scoring (4 or low) had pregnancy interruption. We noted if the fetus don't reach the ecographic criteria in first 20 minutes, anyone had done in 30 minutes. Only three fetus had Apgar score low 7, and we didn't have perinatal deaths. Modified BP is useful in fetal surveillance, this modification is more efficient in human and technological sources

Insulin therapy and its consequences for the mother, foetus, and newborn in gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is a disease characterised by glucose intolerance and first diagnosed in pregnancy. This condition relates to an anomalous placental environment and aberrant placental vascular function. GDM-associated hyperglycaemia changes the placenta structure leading to abnormal development and functionality of this vital organ. Aiming to avoid the GDM-hyperglycaemia and its deleterious consequences in the mother, the foetus and newborn, women with GDM are firstly treated with a controlled diet therapy; however, some of the women fail to reach the recommended glycaemia values and therefore they are passed to the second line of treatment, i.e., insulin therapy. The several protocols available in the literature regarding insulin therapy are variable and not a clear consensus is yet reached. Insulin therapy restores maternal glycaemia, but this beneficial effect is not reflected in the foetus and newborn metabolism, suggesting that other factors than d-glucose may be involved in the pathophysiology of GDM. Worryingly, insulin therapy may cause alterations in the placenta and umbilical vessels as well as the foetus and newborn additional to those seen in pregnant women with GDM treated with diet. In this review, we summarised the variable information regarding indications and protocols for administration of the insulin therapy and the possible outcomes on the function and structure of the foetoplacental unit and the neonate parameters from women with GDM