Yardımcı Üreme Teknikleri İle Oluşan Çoğul Gebeliklerin Değerlendirilmesi Ve Postnatal Maliyet Analizi

Yıl 2018, Cilt: 23 Sayı: 3, 177 - 182, 26.09.2018

Öykü İsal Tosun Elif Yüksel Karatoprak Fahri Ovalı

https://doi.org/10.21673/anadoluklin.397410

Cited By: 1

Öz

Amaç: Çalışmamızda yardımcı üreme teknikleriyle oluşan çoğul gebeliklerden dünyaya gelen
yenidoğanları değerlendirmeyi ve yenidoğan yoğun bakım ünitesine enterne edilen bebeklerin
postnatal maliyet analizini yapmayı amaçladık.

Gereç ve Yöntemler: Yardımcı üreme teknikleriyle oluşan çoğul gebeliklerden doğan ve hastanemizde
takip edilen 123 bebek çalışmamıza dahil edildi.

Bulgular: Bebekler yenidoğan yoğun bakım ünitesine enterne edilenler ve edilmeyenler olarak
ayrıldığında ikiz ve üçüz dağılımlarında ve bebek cinsiyeti dağılımlarında istatistiksel olarak
anlamlı fark izlenmedi (p=0,056; p=0,77). Enterne olanlarda gestasyonel yaş ortalaması, doğum
ağırlığı, boy ve baş çevresi ortalamaları istatistiksel olarak anlamlı derecede düşük bulundu
(p=0,0001). Enterne olan ve olmayanlar için yapılan infertilite tedavileri arasında anlamlı
fark izlenmedi (p=0,036). Enterne olanların takip ve tedavi maliyeti 114.000,0 (min. 248, maks.
229.375,0) TL olarak hesaplandı.

Tartışma ve Sonuç: Yardımcı üreme teknikleriyle oluşan çoğul gebeliklerde prematürite ve düşük
doğum ağırlığı göz ardı edilmeyecek risk faktörleridir ve buna bağlı olarak neonatal mortalite
ve morbidite önemli derecede artmaktadır. Bu durumu önlemek için elektif tek embriyo transferi
daha doğru bir yaklaşım gibi görünmektedir

Anahtar Kelimeler

yardımcı üreme tekniği, yenidoğan, maliyet analizi

An Assessment and Postnatal Cost Analysis of Multiple Pregnancies after Assisted Reproductive Techniques

Öz

Aim: In this study, we aimed to assess newborns from multiple pregnancies after assisted reproductive
techniques and to perform a postnatal cost analysis for those who were interned in
the neonatal intensive care unit (NICU).

Materials and Methods: A total of 123 newborns from multiple pregnancies after assisted reproductive
techniques who were followed up in our hospital were included.

Results: There was no statistically significant difference in twin and triplet distributions and
infant gender distributions when the newborns were divided into those who were interned in
NICU and those who were not (p=0.056; p=0.77). Mean gestational age, birth weight, height,
and head circumference were found statistically significantly lower for those who were interned
(p=0.0001). There was no significant difference between the infertility treatments performed for
the NICU-interned and non-NICU-interned groups (p=0.036). The cost of treatment for those
who were followed up in NICU was calculated to be 114,000.00 (min. 248, max. 229,375.0) TL.

Discussion and Conclusion: In multiple pregnancies after assisted reproductive techniques,
prematurity and low birth weight are risk factors that cannot be neglected, leading to significantly
increased neonatal mortality and morbidity. Elective single embryo transfer appears to
be a more appropriate approach for preventing these outcomes.

Anahtar Kelimeler

assisted reproductive techniques, newborn, cost analysis

Kaynakça

• 1- Ludwig M. Outcome of assisted reproduction. Lancet 2007 ; 370: 351-359
• 2- Chambers GM, Chapman MG, Grayson N, ve ark. Babies born after ART treatment cost more than non-ART treatment: a cost analysis of in patient birth admission costs of singleton and multiple gestation pregnancies. Hum Reprod 2007 ; 22: 2108-15
• 3- UM Reddy, RJ Wagner, RW Rebar. Infertility, Assisted Reproductive Technology and Adverse Pregnancy Outcomes. Obstetric and Gynecology 2007 ; 25: 442
• 4- Langer T, Deeg KH, Paulides M, Beck JD, Klinge J. Postnatal respiratory distress in a dichorial twin with congenital thoracic neuroblastoma after ART by intracytoplasmatic sperm injevtion. Pediatr Blood Cancer 2007; 48: 358-360
• 5- Samancı N. Çoğul gebelikler. Neonatoloji Dağoğlu T, Ovalı F. 2. Baskı 2007; 5: 237-245
• 6- Wright UC, Chang J, Jen G, Mocaluso M. Assisted reproductive technology surveillance- United States. 2006; 55: 1-22
• 7- Blickstein I. Estimation of iatrogenic monozygotic twinning rate following assisted reproductive technology. Am J Obstet Gynecol 2005; 55: 1-22
• 8- Dhant M. Single embryo transfer and multiple pregnancy rate reduction in IVF/ICSI. Hum Reprod. 2005; 20: 2821-2829
• 9- Tanberg A, Tone B, Per E, ark. Increasing twinning rates in Norway,m 1967-2004: the influence of maternal age and assisted reproductive technology. Acta Obstet Gynecol. 2007; 86: 833- 881
• 10- Martin JA, Hamilton BE, Suttan PD, ve ark. Births final data for 2003. Natl Vital Stat Rep 2003;54:118-120
• 11- De Sutter P, Delbare I, Gerris J, ve ark. Birth weight of singletons after ART is higher than singleton after double embryo transfer. Hum Reprod. 2006; 21: 2633-2637
• 12- De Nouberg D, Gerris j, Mangelschots K, ve ark. The obstetrical and neonatal outcome of babies born after IVF/ICSI compares favourably to spontaneously conceived babies. Hum Reprod 2006; 21: 1041-1046
• 13- Finnstroem O. Outcome of multiple pregnancy following ART: the effect on child.Current practices and contraversies in ART , WHO, Geneva, switzerland PP. 2002;235-242
• 14- Ozturk O, Templeton . In vitro fertilisation and risk of multiple pregnancy. Lancet. 2002;19: 232-359
• 15- Westergoard HB, Johansen AM, Erb K, ve ark. Danish National IVF registry 1994 and 1995 controlled study of births, malformations and cytogenetic findings. Hum Reprod 1999; 14:1896- 1902
• 16- Devine PC, Malone FD, Athanassiou A, ve ark. Maternal and neonatal outcome of 100 consecutive triplet pregnancies. Am J Perinatal 2001; 18: 225-235
• 17- Elster N. Less is more: the risk of multiple births. Fertil Steril 2000; 74: 613-617
• 18- Collins JA, Graves GR. The economic conseguences of multiple gestation pregnancy in assisted conception cycles. Hum Fertil 2000; 3: 275-283
• 19- ESHRE Capri Workshop Group. Multiple pregnancy. Hum Reprod 2000; 15: 2821-2829
• 20- Ovalı F. Yenidoğan yoğun bakım ünitesinde maliyet analizi. FatihÜniversitesi Sosyal Bilimler Enstitüsü İşletme Yüksek Lisans Bitirme projesi. İstanbul, 2009