RESUMEN
OBJECTIVE: In March 2010, a new legislation about assisted reproductive technology (ART) activities, favoring single embryo transfer, was introduced in Turkey. Consequences of new regulations on neonatal outcome have not been evaluated in multicenter studies yet. In this study, our aim was to evaluate neonatal outcome of infants from medically assisted reproduction (MAR) pregnancies in the post-legislation era. METHODS: A point prevalence study was conducted at 51 centers in Turkey on 1 April 2013. Data about fertility treatments and neonatal characteristics were evaluated for "live births" (Group 1) and "patients being cared in the NICU" (Group 2). RESULTS: Seventeen (4%) of 420 infants in group 1, and 89 (8.1%) of 1094 infants in group 2 were born after MAR pregnancies. The ratio of multiple births in MAR pregnancies was still very high as 47.1% for group 1, 69.1% for group 2 infants. MAR babies constituted 9.9% of infants in Level 3 NICUs and 7.6% infants in Level 2 NICUs. MAR was associated with increased risk of multiple births and prematurity. CONCLUSIONS: After the new legislation, multiple birth rates are still high in MAR pregnancies, resulting in unfavorable neonatal outcomes. Efforts to decrease multiple birth rates should be encouraged.
Asunto(s)
Resultado del Embarazo/epidemiología , Técnicas Reproductivas Asistidas/legislación & jurisprudencia , Adulto , Tasa de Natalidad/tendencias , Estudios Transversales , Femenino , Regulación Gubernamental , Humanos , Recién Nacido , Recien Nacido Prematuro , Progenie de Nacimiento Múltiple/legislación & jurisprudencia , Progenie de Nacimiento Múltiple/estadística & datos numéricos , Embarazo , Embarazo Múltiple/estadística & datos numéricos , Nacimiento Prematuro/epidemiología , Prevalencia , Técnicas Reproductivas Asistidas/estadística & datos numéricos , Turquía/epidemiologíaRESUMEN
Health professionals are well versed in the need to have systems in place which avoid mishaps happening to patients due to human error or breakdown in communications: for example, legal actions for damages for operations wrongfully performed on patients due to a failure in the identification process; surgery involving the wrong limb or organ; medications being given to the wrong patient. Hospitals set in place systems by which a patient's name and procedures to be performed are checked multiple times throughout the patient's stay. This process is particularly vital when a patient is undergoing a surgical procedure which will be performed under anaesthesia. Nevertheless, systems failures continue to occur resulting in claims for damages by affected patients.
Asunto(s)
Transferencia de Embrión/efectos adversos , Responsabilidad Legal , Mala Praxis/legislación & jurisprudencia , Progenie de Nacimiento Múltiple/legislación & jurisprudencia , Derecho de no Nacer , Territorio de la Capital Australiana , Compensación y Reparación/legislación & jurisprudencia , Transferencia de Embrión/métodos , Transferencia de Embrión/normas , Humanos , Mala Praxis/economía , Gestión de Riesgos/legislación & jurisprudencia , Gestión de Riesgos/métodosRESUMEN
The health benefits of breastfeeding are well known. However, less is known about the frequency and duration of breastfeeding in twins. A population-based study of maternal factors associated with the early cessation of breastfeeding in preterm and term twins is reviewed. This is followed by research reviews and news concerning aging in twins, conjoined twin separation and school legislation for multiple birth children. Twins and quadruplets who have distinguished themselves in the areas of education, fashion design and humanitarian efforts are highlighted.
Asunto(s)
Lactancia Materna/estadística & datos numéricos , Gemelos , Femenino , Humanos , Lactante , Progenie de Nacimiento Múltiple/legislación & jurisprudencia , Embarazo , Embarazo Múltiple/estadística & datos numéricos , Investigación/legislación & jurisprudencia , Gemelos SiamesesRESUMEN
BACKGROUND: In light of the recent octuplet birth and the accompanying intensive media coverage, there has been much attention on high order multiple births resulting from assisted reproductive technology. OBJECTIVES: The purpose of this commentary is to review 1) the relative contribution of ART to high order multiple gestation and its impact on infant morbidity, mortality, and health care dollar loss; 2) American Society of Reproductive Medicine's guidelines for the number of embryos transferred in ART; and 3) how reproductive endocrinologists can lessen their exposure to litigation by following the ASRM guidelines for the number of embryos transferred and documenting proper informed consent in the medical records. RECOMMENDATIONS: In situations in which the number of embryos transferred is in excess of the ASRM guidelines, justification for deviating from the ASRM guidelines should be justifiable and documented in the medical records.
Asunto(s)
Endocrinología/ética , Progenie de Nacimiento Múltiple/legislación & jurisprudencia , Embarazo Múltiple , Técnicas Reproductivas Asistidas/legislación & jurisprudencia , Transferencia de Embrión/métodos , Transferencia de Embrión/tendencias , Femenino , Adhesión a Directriz , Humanos , Guías de Práctica Clínica como Asunto , EmbarazoRESUMEN
Multiple birth rates have increased in most developed countries. The potential of a medical legal dispute increases when complications are common. Failure to perform the basic and standard care follow-up often misses the complication and the chance of a timely referral to a center experienced in the diagnosis and management of these complexities of a multiple pregnancy. In this article, several examples are discussed in which departure from the standard of care of multiple pregnancies were the basis of the allegation.