Causas de mortinatalidad en Chile entre 2002-2015

David Antonio San Martín Roldán, Vezna Sabando Franulic, Alfredo Germain Aravena, Andrés Pons Guerra

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Resumen

Introducción: Un mortinato, es un evento del embarazo que supone un resultado negativo para padres, familias y personal de salud involucrado. La falta de recursos podría ser el principal obstáculo al acceso de atención prenatal, síntoma de inequidades en salud. El débil conocimiento de causas de mortinatalidad se asocia a la creencia de que son inevitables; sin embargo, muchos factores vinculantes son potencialmente modificables.

Objetivo: Describir las causas de mortinatalidad en Chile.

Material y métodos: Estudio transversal y analítico. El análisis se precisó desde las 22 semanas gestacionales, según criterio estándar de la Organización Mundial de la Salud. Las causas de mayor frecuencia se utilizaron para determinar asociación mediante test  con nivel de significación estadística p<0,05.

Resultados: El mayor porcentaje de muertes fetales se registró a las 35 o más semanas (35,63%). Principales macro-causas de mortinatalidad fueron tipo: fetal (47,0%), placentaria (31,4%) y desconocida (10,89%). Principales causas específicas fueron: hipoxia intrauterina (24,4%), causa no especificada (10,87%), y anomalías morfológicas-funcionales placentarias (10,83%). Causa específica hipoxia intrauterina se asocia a edad gestacional, edad materna y nivel educacional materno (p<0,05).

Conclusiones: La salud prenatal es reflejo de atención obstétrica, calidad y progreso en atención sanitaria. Existen brechas en detección de causas y calidad de los registros, por lo que las causas desconocidas tiendan al alza en el tiempo. Es recomendable adicionar al registro de muertes fetales componentes temporal, biológico y social maternos.

Palabras claves: Mortinatalidad, muerte fetal, inequidades en salud, resultado del embarazo, causas de muerte, factores de riesgo.

Palabras clave

Mortinatalidad, muerte fetal, inequidades en salud, resultado del embarazo, causas de muerte, factores de riesgo.

Referencias

Reinebrant H, Leisher S, Coory M, Henry S, Wojcieszek A, Gardener G, et al. Making stillbirths visible: a systematic review of globally reported causes of stillbirth. BJOG: An International Journal of Obstetrics & Gynaecology [Internet]. 2017 Nov 29;125(2):212–24. [Cited: 18/12/2018]. Available from: http://dx.doi.org/10.1111/1471-0528.14971

Gopichandran V, Subramaniam S, Kalsingh MJ. Psycho-social impact of stillbirths on women and their families in Tamil Nadu, India – a qualitative study. BMC Pregnancy and Childbirth [Internet]. 2018 Apr 20;18(1):109. [Cited: 18/12/2018]. Available from: http://dx.doi.org/10.1186/s12884-018-1742-0

De Bernis L, Kinney MV, Stones W, ten Hoope-Bender P, Vivio D, Leisher SH, et al. Stillbirths: ending preventable deaths by 2030. The Lancet [Internet]. 2016 Feb;387(10019):703–16. [Cited: 28/12/2018]. Available from: http://dx.doi.org/10.1016/S0140-6736(15)00954-X

Pásztor N, Keresztúri A, Kozinszky Z, Pál A. Identification of Causes of Stillbirth Through Autopsy and Placental Examination Reports. Fetal and Pediatric Pathology [Internet]. 2013 Nov 5 ;33(1):49-54. [Cited: 28/12/2018]. Available from: http://dx.doi.org/10.3109/15513815.2013.850132

Pons A, Sepúlveda E, Leiva JL, Rencoret G, Germain A. Muerte fetal. REV MED CLIN CONDES [Internet]. 2014;25(6):908-16. [Cited: 30/08/2018]. Disponible en: https://www.clinicalascondes.cl/Dev_CLC/media/Imagenes/PDF%20revista%20m%C3%A9dica/2014/6%20Nov/10-pons.pdf

Chen K, Seow K, Chen L. The role of preterm placental calcification on assessing risks of stillbirth. Elsevier [Internet]. 2015;36(9):1039-44. [Cited: 28/08/2018]. Available from: http://dx.doi.org/10.1016/j.placenta.2015.06.015

WHO: World Health Organization [Internet]. Geneve: WHO; True magnitude of stillbirths and maternal and neonatal deaths underreported. 2016. [Cited: 29/08/2018]. Available from: https://www.who.int/news-room/detail/16-08-2016-true-magnitude-of-stillbirths-and-maternal-and-neonatal-deaths-underreported

Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, et al. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet [Internet]. 2016 Feb;387(10018):587-603. [Cited: 18/07/2017]. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0140673615008375

Lawn JE, Blencowe H, Pattinson R, Cousens S, Kumar R, Ibiebele I, et al. Stillbirths: Where? When? Why? How to make the data count? Lancet [Internet]. 2011;377(9775):1448–63. [Cited: 18/07/2017]. Available from: http://dx.doi.org/10.1016/S0140-6736(10)62187-3

Tilahun D, Assefa T. Incidence and determinants of stillbirth among women who gave birth in Jimma University specialized hospital, Ethiopia. PanAfrican Medican J [Internet]. 2017;8688:1–11. [Cited: 18/02/2018]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5927570/pdf/PAMJ-28-299.pdf

WHO: World Health Organization. [Internet]. Geneve: WHO; Making every baby count: audit and review of stillbirths and neonatal deaths. c2016. [Cited: 18/02/2018]. Available from: https://www.who.int/maternal_child_adolescent/documents/stillbirth-neonatal-death-review/en/

Flenady V, Koopmans L, Middleton P, Froen JF, Smith GC, Gibbons K, et al. Major risk factors for stillbirth in high-income countries: A systematic review and meta-analysis. Lancet [Internet]. 2011;377(9774):1331-40. [Cited: 18/02/2018]. Available from: http://dx.doi.org/10.1016/S0140-6736(10)62233-7

Akseer N, Lawn JE, Keenan W, Konstantopoulos A, Cooper P, Ismail Z, et al. Ending preventable newborn deaths in a generation. International Journal of Gynecology & Obstetrics [Internet]. 2015 Sep 30;131:S43–8. [Cited: 15/03/2018]. Available from: http://dx.doi.org/10.1016/j.ijgo.2015.03.017

De Bernis L, Kinney MV, Stones W, ten Hoope-Bender P, Vivio D, Leisher SH, et al. Stillbirths: ending preventable deaths by 2030. Lancet [Internet]. 2016 Feb;387(10019):703-16. [Cited: 18/07/2017]. Available from: http://linkinghub.elsevier.com/retrieve/pii/S014067361500954X

Frøen JF, Friberg IK, Lawn JE, Bhutta ZA, Pattinson RC, Allanson ER, et al. Stillbirths: progress and unfinished business. The Lancet [Internet]. 2016 Feb;387(10018):574–86. [Cited: 08/12/2018]. Available from: http://dx.doi.org/10.1016/S0140-6736(15)00818-1

Bukowski R, Carpenter M, Conway D, Coustan D, Dudley DJ, Goldenberg RL, et al. Causes of Death Among Stillbirths. Jama [Internet]. 2011;306(22):2459-68. [Cited: 08/12/2018]. Available from: http://jama.jamanetwork.com/article.aspx?articleid=1104720

Ramonienė G, Maleckienė L, Nadišauskienė RJ, Bartusevičienė E, Railaitė DR, Mačiulevičienė R, et al. Maternal obesity and obstetric outcomes in a tertiary referral center. Medicina [Internet]. 2017;53(2):109-13. [Cited: 04/02/2018] Available from: http://dx.doi.org/10.1016/j.medici.2017.03.003

MINSAL: Ministerio de Salud de Chile. Bases de datos defunciones fetales [Internet]. DEIS: Departamento de estadísticas e información de salud. 2018. [Citado: 12/11/2018]. Disponible en: http://www.deis.cl/bases-de-datos-defunciones-fetales/

Aminu M, Unkels R, Mdegela M, Utz B, Adaji S, van den Broek N. Causes of and factors associated with stillbirth in low- and middle-income countries: a systematic literature review. BJOG: An International Journal of Obstetrics & Gynaecology [Internet]. 2014 Sep;121:141-53. [Cited: 02/12/2017]. Available from: http://dx.doi.org/10.1111/1471-0528.12995

Goldenberg RL, McClure EM, Bhutta ZA, Belizán JM, Reddy UM, Rubens CE, et al. Stillbirths: the vision for 2020. The Lancet [Internet]. 2011 May;377(9779):1798–805. [Cited: 02/12/2017]. Available from: http://dx.doi.org/10.1016/S0140-6736(10)62235-0

Frøen JF, Cacciatore J, McClure EM, Kuti O, Jokhio AH, Islam M, et al. Stillbirths: why they matter. The Lancet [Internet]. 2011 Apr;377(9774):1353-66. [Cited:02/12/2017]. Available from: http://dx.doi.org/10.1016/S0140-6736(10)62232-5

MINSAL: Ministerio de Salud de Chile [Internet]. Santiago MINSAL; c2015. [Citado: 26/10/2017]. Guía Perinatal 1-466. Disponible en: https://www.minsal.cl/sites/default/files/files/GUIA%20PERINATAL_2015_%20PARA%20PUBLICAR.pdf

Milad AM, Novoa JM, Fabre BJ, Samané MM, Aspillaga C. Recomendación sobre Curvas de Crecimiento Intrauterino. Revista Chilena de Pediatría [Internet]. 2010 jun;81(3). [Citado: 26/10/2017]. Available from: http://dx.doi.org/10.4067/S0370-41062010000300011

Ministerio de Sanidad Servicios Sociales e Igualdad. Avanzando hacia la equidad. Propuesta de políticas e intervenciones para reducir las desigualdades sociales en salud en España. Inf Estud e Investig [Internet]. 2015. [Citado: 26/10/2017]. Disponible en: https://www.msssi.gob.es/profesionales/saludPublica/prevPromocion/promocion/desigualdadSalud/docs/Propuesta_Politicas_Reducir_Desigualdades.pdf%0Ahttp://iudesp.ua.es/es/documentos/publicaciones/comision-para-reducir-lhttps-vuala-ua-es-index-php-as-desigua

Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, et al. Stillbirths: rates, risk factors, and acceleration towards 2030. The Lancet [Internet]. 2016 Feb;387(10018):587-603. [Cited: 30/11/2018]. Available from: http://dx.doi.org/10.1016/S0140-6736(15)00837-5

Social Trends Institute. The Sustainable Demographic Dividend. 2010; 48 p. [Cited: 21/05/2017]. Available from: http://sustaindemographicdividend.org/wp-content/uploads/2012/07/SDD-2011-Final.pdf

McNamara K, Meaney S, O’Donoghue K. Intrapartum fetal death and doctors: a qualitative exploration. Acta Obstetricia et Gynecologica Scandinavica [Internet]. 2018 Apr 21;97(7):890-8. [Cited: 30/01/2019] Available from: http://dx.doi.org/10.1111/aogs.13354

ANZSA (Coordinating Centre). Investigating the causes of stillbirth ; a prospective cohort study examining use and effectiveness of a comprehensive investigation protocol [Internet]. South Brisbane: ANZSA Coordinating Centre Mater Medical Research Institute Raymond; 2013; 19 p. [Cited: 30/01/2019]. Available from: www.stillbirthalliance.org.au

Darmstadt GL, Shiffman J, Lawn JE. Advancing the newborn and stillbirth global agenda: priorities for the next decade. Archives of Disease in Childhood [Internet]. 2015 Jan 22;100(Suppl 1):S13–8. [Cited: 09/06/2016]. Available from: http://dx.doi.org/10.1136/archdischild-2013-305557

Lakew D, Tesfaye D, Mekonnen H. Determinants of stillbirth among women deliveries at Amhara region, Ethiopia. BMC Pregnancy and Childbirth [Internet]. 2017 Nov 13;17(1). [Cited: 13/02/2019]. Available from: http://dx.doi.org/10.1186/s12884-017-1573-4

Leisher SH, Teoh Z, Reinebrant H, Allanson E, Blencowe H, Erwich JJ, et al. Seeking order amidst chaos: a systematic review of classification systems for causes of stillbirth and neonatal death, 2009-2014. BMC Pregnancy and Childbirth [Internet]. 2016 Oct 5;16(1). [Cited: 13/12/2018]. Available from: http://dx.doi.org/10.1186/s12884-016-1071-0

Pásztor N, Keresztúri A, Kozinszky Z, Pál A. Identification of Causes of Stillbirth Through Autopsy and Placental Examination Reports. Fetal Pediatr Pathol [Internet]. 2014 Feb 5;33(1):49–54. [Cited: 03/08/2017]. Available from: http://www.tandfonline.com/doi/full/10.3109/15513815.2013.850132

Thorsten V, Dudley D, Parker C, Koch M, Hogue C, Stoll B, et al. Stillbirth, Inflammatory Markers, and Obesity: Results from the Stillbirth Collaborative Research Network. American Journal of Perinatology [Internet]. 2018 Apr 2;35(11):1071-8. [Cited: 01/03/2019]. Available from: http://dx.doi.org/10.1055/s-0038-1639340

Lehner C, Harry A, Pelecanos A, Wilson L, Pink K, Sekar R. The feasibility of a clinical audit tool to investigate stillbirth in Australia - a single centre experience. Australian and New Zealand Journal of Obstetrics and Gynaecology [Internet]. 2018 Mar 23; 59(1):59-65. [Cited: 02/02/2019]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29569709/



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