RESUMEN
OBJECTIVE: To determine if quantification of blood loss (QBL) would result in fewer activations of postpartum hemorrhage (PPH) protocols than visual estimation of blood loss (EBL) after cesarean birth and to track the use of related resources. DESIGN: Prospective observational trial. SETTING: A tertiary academic medical center in the midwestern United States. PARTICIPANTS: A total of 42 cases of cesarean birth. METHODS: We visually estimated blood loss during cesarean birth and quantified blood loss with colorimetric testing after the surgery. We compared EBL to QBL in four categories, from no hemorrhage to severe PPH, and documented resources used for women placed on the institutional PPH protocol by EBL who did not meet criteria for PPH by QBL. RESULTS: The median EBL was 1,275 ml (interquartile range = 1,100-1,510 ml), and the median QBL was 948 ml (interquartile range = 700-1,267 ml, p < .001). Twenty-four (57%) instances of PPH based on visual EBL would not have been classified as such based on QBL. The most frequently used resources in these cases included laboratory testing and administration of uterotonics. CONCLUSION: Use of QBL during cesarean births would have reduced the number of identified PPHs by more than 50% over visual EBL and may have reduced the resources used as part of care.
Asunto(s)
Pérdida de Sangre Quirúrgica/enfermería , Guías como Asunto/normas , Hemorragia Posparto/terapia , Pesos y Medidas/normas , Adulto , Femenino , Humanos , Hemorragia Posparto/enfermería , Embarazo , Estudios Prospectivos , Pesos y Medidas/instrumentaciónRESUMEN
Although the birth of a child is typically considered a very happy time for parents, surrogacy is often unchartered territory that can become very stressful for all parties involved. Part of the stress stems from the fact that different states and countries have varying laws and regulations overseeing surrogacy. This article provides insight regarding surrogacy around the world, including professional, societal and ethical issues.
Asunto(s)
Ética , Internacionalidad , Madres Sustitutas/legislación & jurisprudencia , Madres Sustitutas/psicología , Coerción , Comercio , Honorarios y Precios , Femenino , Humanos , Embarazo , Política Pública , Factores Socioeconómicos , Madres Sustitutas/estadística & datos numéricosRESUMEN
In the United States and throughout the world, today's healthcare providers are challenged by the risks of multiple gestation pregnancy. Assisted reproductive technologies (ARTs) often used to treat infertility raise ethical issues including informed consent, veracity, and nonmalificence. In the United States, there is the need to improve maternal and fetal/neonatal mortality and morbidity by proposing legislation regulating ART and supporting single embryo transfers with no more than 2 such transfers. Beginning with the diagnosis of infertility, providers have a responsibility to educate, inform, and treat infertile couples. From the moment pregnancy with multiples is confirmed, these families are faced with incredible stressors including decision making on multifetal or selective reduction. Full disclosure of risks involved throughout the course of care should be discussed and documented in the record and plan of care. Currently in the United States, legislation does not regulate ART, including ovulation induction/enhancement and in vitro fertilization. Although the United States does have self-regulation via limited reporting through their professional organization and the Centers for Disease Control and Prevention, an unlimited number of embryos may be transferred. Unfortunately, many healthcare providers have not recognized the responsibility and burden placed on families and society as a whole. Lack of regulation means women may become pregnant with high order multiples, which raises serious moral and ethical issues.