ABSTRACT
Objetivo: Describir las causas de la interrupción terapéutica del embarazo en el Instituto Nacional Materno Perinatal. Diseño: Estudio observacional descriptivo, tipo revisión de casos. Institución: Instituto Nacional Materno Perinatal, Lima, Perú. Material: Solicitudes para interrupción terapéutica del embarazo. Métodos: Se revisó todos los casos de interrupción terapéutica del embarazo realizados en los diferentes servicios de la institución entre los años 2009 y el 2013. Principales medidas de resultados: Causas de las solicitudes para interrupción terapéutica del embarazo. Resultados: Durante el período de estudio se presentaron a la Dirección General del Instituto 64 solicitudes para interrupción terapéutica del embarazo, de las cuales 61 fueron aprobadas por Junta Médica: una el año 2009, una en el 2010, cuatro en el año 2011, 21 en el 2012 y 34 en el 2013. La edad media de las pacientes fue 30,4 años (19 a 47 años); la mayoría de pacientes tuvo de uno a dos partos previos (47%); el 69% no tenía antecedente de un aborto previo; y la mayoría (31 casos, 51%) llevaba entre 19 y 22 semanas de gestación. Las causas para la interrupción terapéutica del embarazo fueron por riesgo de la vida de la gestante en 8 (13%) casos, y por riesgo en la salud física y mental de la gestante en 53 (87%) casos. La causa más frecuente por riesgo de vida de la gestante fue el lupus eritematoso sistémico activo y las causas por riesgo de la salud física y mental incluyeron las malformaciones congénitas fetales incompatibles con la vida, como anencefalia y acrania. Para la interrupción del embarazo se utilizó con mayor frecuencia el misoprostol más legrado uterino (82%, n = 50). Conclusiones: La proporción de casos de interrupción terapéutica del embarazo está aumentando con el tiempo y la mayoría es por causas que ponen en riesgo la salud física y mental de la madre, como son las malformaciones congénitas del feto incompatibles con la vida extrauterina. Se vienen aplicando los protocolos establecidos en las Guías de Obstetricia y Perinatología del Instituto Nacional Materno Perinatal para la interrupción terapéutica del embarazo.
Objective: To determine causes of medical termination of pregnancy at a national maternal perinatal institute. Design: Descriptive observational study. Setting: Instituto Nacional Materno Perinatal, Lima, Peru. Material: Applications for therapeutic termination of pregnancy. Method: Review of all applications for medical termination of pregnancy performed at the institution between 2009 and 2013. Main outcome measures: Medical reasons for therapeutic termination of pregnancy. Results: During the study period 64 applications for medical termination of pregnancy were submitted to the General Director of the Institute; 61 were approved by the Medical Board: one in 2009, one in 2010, four in 2011, 21 in 2012 and 34 in 2013. The mean age of patients was 30.4 years (19-47 years); most patients had one or two previous deliveries (47%); 69% had no history of previous abortion, and the majority (31 cases, 51%) carried a 19-22 weeks of gestation. The causes for therapeutic termination of pregnancy were risk of life in 8 (13%) pregnant women and risk for physical and mental health in 53 (87%). The most frequent cause the mother considered as risk of life was active systemic lupus erythematosus, and as risk for physical and mental health, fetal congenital malformations incompatible with life including anencephaly and acrania. Misoprostol and uterine curettage were the most often methods (82%, n = 50) used for termination of pregnancy. Conclusions: Cases of therapeutic termination of pregnancy have increased over time at our institution. Most have been due to causes that endangered the mothers physical and mental health such as fetal congenital malformations incompatible with extrauterine life. Obstetric and perinatology guidelines for therapeutic termination of pregnancy are being formally applied at the Instituto Nacional Materno Perinatal.
ABSTRACT
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.