ABSTRACT
Objective: The aim of this study was to evaluate the impact on perinatal outcomes related to placental insufficiency with the application of the new 2017 ACC/AHA guidelines to a group of chronic hypertensive pregnancies during their first-trimester assessment. Study design: This retrospective cohort study included pregnancies with preconceptional hypertension and known perinatal outcomes. In the first trimester, a combined screening for preterm preeclampsia (p-PE) was performed, including blood pressure (BP), mean uterine artery Doppler, and maternal characteristics. Patients were divided, according to the 2017 ACC/AHA consensus, into the following groups: elevated or less, Stage 1, and Stage 2. For adverse perinatal outcome assessment, univariate and multivariate regression analyses were performed, considering the "elevated or less" group as a reference. Odds ratios (OR) were compared with linear trend analysis. The main outcomes measured were preterm PE and FGR < 3 rd percentile. Results: Of the 130 included patients, 59 (45.4%) were classified as elevated or less, 47 (36.2%) as Stage 1, and 24 (18.4%) as Stage 2. p-PE showed a significant increase according to BP range [7% (OR = 1.0), 19.6% (OR = 3.2), and 21.7% (OR = 3.7)]; trend p = 0.02, for elevated or less, Stage 1, and Stage 2, respectively. There was a non-significant increased trend of FGR < 3 rd percentile according to the BP stage. The best multivariate predictive model for p-PE included a previous PE background (OR = 15) and mean arterial pressure in mmHg (OR = 1.1). Conclusion: The use of the 2017 ACC/AHA consensus in pregnancies with chronic hypertension identifies an intermediate risk group for placental-mediated diseases.
ABSTRACT
Objective: To describe the current situation of the dental profession in Chile, including training and workforce issues. Material and Methods: Data were collected from different national institutions, which included information regarding number of current registered dentists, university of graduation, geographical distribution, professional position, additional specialty certifications obtained, the number and characteristics of dental surgeons who work in the public and private sectors, the traditional character of the university, the accreditation status of the undergraduate dental programs and the general population number. Results: Currently there are 32 schools of Dentistry in Chile, of which 21 have their quality certified. There are 19,100 Chilean dentists and 1,727 foreign dentists registered. The number of graduates from private universities has increased significantly. Currently, 2,164 dentists work for MINSAL. Less than a third hold a specialty certification. Forty-five percent of the dental specialists obtained their certification from universities. The current professional ratio is 104 dentists per 100,000 habitants. Conclusion: The number of dentists in Chile has increased progressively during the last years, mainly associated with the opening of new dental schools. Only 28% of the Chilean dental schools have certified their quality for the total duration of the undergraduate program. Regarding the workforce, there is a public/private and geographical inequities in dentists' distribution.
