{"id":10592,"date":"2020-07-07T12:09:06","date_gmt":"2020-07-07T12:09:06","guid":{"rendered":"https:\/\/jurmed.ro\/medici\/?p=10592"},"modified":"2020-07-07T12:09:06","modified_gmt":"2020-07-07T12:09:06","slug":"romania-nu-are-in-acest-moment-o-lege-a-reproducerii-umane-asistate-care-sa-permit-societatii-in-ansamblu-sa-evolueze","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/medici\/romania-nu-are-in-acest-moment-o-lege-a-reproducerii-umane-asistate-care-sa-permit-societatii-in-ansamblu-sa-evolueze\/","title":{"rendered":"Rom\u00e2nia NU are \u00een acest moment o Lege a\u00a0reproducerii umane asistate care s\u0103 permit societ\u0103\u0163ii \u00een ansamblu s\u0103 evolueze"},"content":{"rendered":"
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Dr. MIRCEA ONOFRIESCU Profesor Emerit Departamentul de Obstetric\u0103 \u0219i Ginecologie Universitatea de Medicin\u0103 \u0219i Farmacie Ia\u0219i \u2022 Pre\u0219edinte Societatea Rom\u00e2n\u0103 Medicin\u0103 Reproductiv\u0103 Spitalul de Obstetric\u0103 \u0219i Ginecologie Cuza Vod\u0103, Ia\u0219i<\/em><\/figcaption><\/figure>\n

\u00a0Care a fost \u0219i care este situa\u0163ia din maternit\u0103\u0163i \u00een pandemia de COVID?<\/strong><\/p>\n

A fost \u0219i este o perioad\u0103 foarte intens\u0103 din punct de vedere medical. Numeroase gravide din jude\u0163ele Moldovei au dorit s\u0103 nasc\u0103 la Maternitatea Cuza Vod\u0103 Ia\u0219i mai ales din jude\u0163ele Suceava, Boto\u0219ani, Neam\u0163, Vaslui, Vrancea unde inciden\u0163a cazurilor pozitive era foarte mare \u0219i spitalele jude\u0163ene au fost spitale Covid. Toate cazurile grave, toate cazurile cu patologie asociat\u0103 sarcinii, to\u0163i copii prematuri au fost primite prin transfer \u0219i rezolvate \u00een Maternitatea noastr\u0103. Am avut materialele necesare \u0219i am avut circuitele necesare de la \u00eenceputul pandemiei \u0219i gra\u0163ie implic\u0103rii tuturor cadrelor medicale situa\u0163ia epidemiei a fost sub control. Zilnic au n\u0103scut \u00eentre 15 \u0219i 25 gravide \u00een spitalul nostru multe dintre ele venind din zone ro\u0219ii. Au fost perioade c\u00e2nd 4-5 cazuri au trebuit asistate pentru na\u0219tere \u00een sectorul suspect Covid Pozitiv. Toate au avut evolu\u0163ie favorabil\u0103. Cazurile confirmate pozitiv dup\u0103 momentul na\u0219terii au fost trimise la Spitalul de Boli Contagioase dup\u0103 na\u0219tere sau la Maternitatea Elena Doamna. Boala nu a fost trasmis\u0103 la personalul medical sau la alte paciente internate \u0219i nici la noi n\u0103scu\u0163i.<\/em><\/p>\n

\u00a0Cum se prezint\u0103 situa\u0163ia la Ia\u0219i \u00een ceea ce prive\u0219te num\u0103rul gravidelor infectate cu covid \u0219i care au n\u0103scut? <\/strong><\/p>\n

Num\u0103rul gravidelor confirmate Covid positive au fost de 30. Toate au avut o na\u0219tere monotizat\u0103 corect. Un singur copil de 1000g n\u0103scut la Maternitatea Elena Doamna dintr-o mam\u0103 Covid Pozitiv\u0103 \u0219i transferat dup\u0103 na\u0219tere la Cuza Vod\u0103 a decedat datorit\u0103 prematurit\u0103\u0163ii severe \u0219i patologiei materne asociate. Am avut trei cadre medicale asistente medicale \u0219i infirmiere care au fost depistate pozitiv, ele contact\u00e2nd infec\u0163ia din familie sau din comunitate. Pentru c\u0103 am respectat strict regulile de protec\u0163ie \u00een spital nu a fost transmis\u0103 infec\u0163ia la colegi sau alte paciente.<\/em><\/p>\n

\u00a0O eventual\u0103 infec\u0163ie cu virusul SARS COV 2 \u00een primul trimestru de sarcin\u0103 afectez\u0103 embrionul? <\/strong><\/p>\n

Infec\u0163ia cu virusul SARS COV 2 nu afecteaz\u0103 f\u0103tul dac\u0103 infec\u0163ia se produce \u00een primul trimestru de sarcin\u0103, nu determin\u0103 malforma\u0163ii fetale. Dac\u0103 evolu\u0163ia este cu febr\u0103, simptomatologie respiratorie \u0219i interesare sever\u0103 pulmonar\u0103 riscul de avort si de na\u0219tere prematur\u0103 este foarte mare.<\/em><\/p>\n

\u00a0Exist\u0103 recomand\u0103ri din partea OMS cu privire la modul de na\u0219tere al gravidelor infectate cu sars cov2? <\/strong><\/p>\n

Exist\u0103 protocoale interna\u0163ionale \u0219i un protocol national realizat de Societatea Rom\u00e2n\u0103 de Obstetric\u0103 Ginecologie \u0219i Societatea Rom\u00e2n\u00e2 de Neonatologie care precizeaz\u0103 modul de monitorizare a sarcinii, de spitalizare \u0219i bine\u00een\u0163eles de na\u0219tere. Pacientele Covid Pozitive pot na\u0219te natural sau \u00een func\u0163ie de gravitatea infec\u0163iei virale sau a indica\u0163iilor obatetricale pot na\u0219te prin opera\u0163ie cezarian\u0103 sub anestezie rahidian\u0103.<\/em><\/p>\n

\u00a0Cum au fost afectate de pandemie tinerele cupluri care doreau s\u0103 opteze pentru procesul de vertilizare in vitro?<\/strong><\/p>\n

Multe cupluri au fost dezam\u0103gite c\u0103 activitatea \u00een Clinicile de Fertilizare in vitro pentru o perioad\u0103 de aproximativ dou\u0103 luni a fost suprimat\u0103. Am relaut cu respectarea m\u0103surilor de protec\u0163ie \u0219i avem deja sarcini ob\u0163inute dup\u0103 cicluri de fertilizare efectuate sau dup\u0103 transferal de embrioni congela\u0163i dup\u0103 niste procedure de FIV efectuate anterior. Toate cuplurile care \u00eencep un ciclu de FIV trebuie s\u0103 fie testate \u0219i ulterior sunt destate \u00een ziua punc\u0163iei ovariene pentru recoltarea de ovocite. La fel \u00een caz de embriotransfer de embrioni congela\u0163i pacientele sunt testate anterior embriotransferului. Sunt protocoale na\u0163ionale \u0219i interna\u0163ionale care sunt cunoscute \u0219i respectate.<\/em><\/p>\n

\u00a0Teama infertilit\u0103\u0163ii cuplurilor este tot mai prezent\u0103 \u00een societatea noastr\u0103. Unde ne situ\u0103m ca \u0163ara \u00een statisticile europene ceea ce prive\u0219te num\u0103rul anual de na\u0219teri \u0219i nr de cupluri afectate de infertilitate?<\/strong><\/p>\n

Infertilitatea (sterilitatea) este definit\u0103 ca find lipsa concep\u0163iei dup\u0103 un an de zile de contact sexual neprotejat, iar dup\u0103 v\u00e2rsta de 35 de ani intervalul se scurteaz\u0103 la 6 luni. Afecteaz\u0103 aproximativ 10% din cupluri, \u015fi se estimeaz\u0103 ca apar \u00een jur de 2 milioane de noi cupluri infertile pe an \u015fi num\u0103rul lor este \u00een cre\u0219tere. V\u00e2rsta mamei la na\u0219terea primului copil cre\u0219te abrupt \u0219i rata fertilit\u0103\u0163ii scade foarte mult. Dup\u0103 ultimul recens\u0103m\u00e2nt din Rom\u00e2nia, Rata total\u0103 de fertilitate 1,3 copii pe femeie! \u2013 una dintre cele mai mici din Europa! .<\/em><\/p>\n

Se estimeaz\u0103 c\u0103 \u00een acest ritm, \u00een 2050, Rom\u00e2nia va ajunge la o popula\u0163ie de doar 14 milioane de locuitori, fa\u0163\u0103 de aproximativ 19 milioane, c\u00e2t sunt \u00een prezent.<\/em><\/p>\n

Avem cel mai mic num\u0103r de proceduri de Fertilizare in Vitro din Europa de Est! \u2013 \u00een jur de 5000 din care numai 1500 sunt sus\u0163inute PAR\u0162IAL de stat!<\/em><\/p>\n

\u00cen \u0163\u0103rile din fosta Iugoslavie, \u00een Bulgaria p\u00e2n\u0103 \u015fi \u00een Kosovo \u015fi Macedonia guvernele sus\u0163in 3-4 proceduri de fertilizare in vitro pentru fiecare cuplu infertil care se adresez\u0103 serviciilor de reproducere medical\u0103 asistat\u0103 \u0219i care au ni\u0219te criterii de includere care s\u0103 permit\u0103 ob\u0163inerea unei sarcini cu mari \u0219anse de reu\u0219it\u0103. Sper\u00e2m \u00een continuare ca \u0219i \u00een Rom\u00e2nia vor fi sus\u0163inute cuplurile fertile cu \u0219anse \u0219i indica\u0163ii recunoscute prin sus\u0163inerea financiar\u0103 a trei cicluri de FIV.<\/em><\/p>\n

Recomand\u0103rile Societ\u0103\u0163ilor Europene recomand\u0103 ca optim un num\u0103r de 1500 de cicluri de FIV la milionul de locuitori. Rom\u00e2nia este departe de aceste recomand\u0103ri 300 cicluri\/milionul de locuitori. Danemarca (2726 cicluri de FIV\/milion), Belgia (2562 cicluri de FIV\/milion), Cehia (1851 cicluri de FIV\/milion), Slovenia (1840 cicluri de FIV\/milion), Suedia (1800 cicluri de FIV\/milion),\u00a0 Finlanda (1701 cicluri de FIV\/milion),\u00a0 Norvegia (1780 cicluri de FIV\/milion).<\/em><\/p>\n

\u00cen \u0163\u0103ri ca Spania, cu rate similare de fertilitate, aproximativ\u00a0 2% – 3% din to\u0163i copii sunt n\u0103scu\u0163i prin tehnici de reproducere uman\u0103 asistat\u0103 (RUA). \u00cen Danemarca, aprox. 6% din to\u0163i copiii, sunt n\u0103scuti dup\u0103 folosirea de RUA.<\/em><\/p>\n

Cu toate demersurile f\u0103cute de Societatea Rom\u00e2n\u0103 de Obstetric\u0103 \u0219i Ginecologie, a Societ\u0103\u0163ii Rom\u00e2ne de Medicin\u0103 Reproductiv\u0103 NU au fost g\u0103site fondurile necesare pentru a se extinde programul de fertilizare in vitro. Av\u00e2nd \u00een vedere c\u0103 \u015fi cuplurile infertile pl\u0103tesc asigur\u0103ri sociale, iar infertilitatea este recunoscut\u0103 de OMS ca boal\u0103, putem aprecia c\u0103 o singur\u0103 fertilizare compensat\u0103 pe jum\u0103tate este cam pu\u0163in. Rom\u00e2nia a avut \u00een 2017 doar 500 de cicluri de FIV pl\u0103tite par\u0163ial, iar Polonia 15.000 cicluri pl\u0103tite de casele de asigur\u0103ri de s\u0103n\u0103tate, Rom\u00e2nia \u00eenc\u0103 se zbate s\u0103 g\u0103seasc\u0103 drumul \u00een cea\u0163\u0103. A privi tehnicile de reproducere uman\u0103 asistat\u0103 ca pe ceva rar, c\u00e2nd \u00een lume s-au n\u0103scut peste \u0219ase milioane de copii este ceva arhaic. Suntem \u0163ara care face cel mai pu\u0163in pentru reproducerea uman\u0103 asistat\u0103, pentru cuplurile infertile care ar dori copii.<\/em><\/p>\n

\u00a0<\/strong>Care sunt efectele secundare ale procedurilor de FIV \u0219i care sunt recomand\u0103rile dumneavoastr\u0103 privind aceste proceduri?<\/strong><\/p>\n

\u00cen acest moment Clinicile de FIV din Rom\u00e2nia au la dispozi\u0163ie medici cu o preg\u0103tire european\u0103, acces la cele mai noi \u0219i eficiente protocoale de stimulare \u0219i de laboratoare dotate european \u00een care lucreaz\u0103 embriologi cu atestare european\u0103. Sindromul de hiperstimulare ovarian\u0103, o complica\u0163ie a tehniclor de FIV, practic a fost exclus prin utilizarea noilor protocoale de stimulare. Sarcina multipl\u0103 reprezint\u0103 o alt\u0103 complica\u0163ie care este evitat\u0103 prin transferului unui singur embrion de ziua a 5 (blastocist). Sunt \u00een continuare trist c\u00e2nd constat paciente care fac FIV \u00een alte \u0163\u0103ri din vecin\u0103tate \u0219i la care se transfer\u0103 2 sau 3 embrioni cu evolu\u0163ie sever\u0103 a sarcinilor si cel mai grav cu pierderea copiilor at\u00e2t de dori\u0163i.<\/em><\/p>\n

Sunt \u00eenc\u00e2ntat c\u0103 multe cupluri de rom\u00e2ni care lucreaz\u0103 \u00een Anglia, Fran\u0163a, Italia, Spania vin s\u0103 fac\u0103 cicluri de FIV \u00een Romania \u0219i ob\u0163in copiii mult dori\u0163i. \u00cen Londra Centrul nostru Omini de la Ia\u0219i are o gradini\u0163\u0103 de copii ob\u0163inu\u0163i prin FIV f\u0103cut la Ia\u0219i.<\/em><\/p>\n

\u00a0 <\/strong>Care este situa\u0163ia cadrului legislativ \u00een ceea ce prive\u015fte reproducerea uman\u0103 asistat\u0103 \u00een Rom\u00e2nia? Ce prevede programul na\u0163ional de s\u0103n\u0103tate referitor la fertilizare in vitro \u0219i embriotransfer?<\/strong><\/p>\n

Rom\u00e2nia NU are \u00een acest moment o Lege a reproducerii umane asistate care s\u0103 permit\u0103 societ\u0103\u0163ii \u00een ansamblu s\u0103 evolueze: s\u0103 permit\u0103 don\u0103rile de game\u0163i, dar cu realizarea unui registru cu donorii at\u00e2t de ovocite, c\u00e2t \u015fi cu cei de sperm\u0103, care s\u0103 poat\u0103 dona de un num\u0103r limitat de ori. Proiectul de Lege este de mul\u0163i ani \u00een Comisia de S\u0103n\u0103tate a Camerei Deputa\u0163ilor \u0219i nu poate s\u0103 avanseze \u00een condi\u0163iile \u00een care speciali\u0219tii \u0219i-au spus punctul de vedere. \u0162ara noastr\u0103 ar trebui s\u0103 fie curajoas\u0103 precum Spania, turismul medical din reproducerea uman\u0103 asistat\u0103 aduce fonduri importante pentru \u0163ar\u0103. \u00cen Spania, cuplurile vin la tratament pentru calitate, \u015fi asta datorit\u0103 legisla\u0163iei curajoase \u2013 permisive, dar controlate.<\/em><\/p>\n

Este absolut necesar s\u0103 se realizeze Registru Na\u0163ional al procedurilor de FIV \u0219i IUI. Multe Centre de FIV din Rom\u00e2nia comunic\u0103 la ESHRE (Societatea European\u0103 de Reproducere Uman\u0103 Asistat\u0103 \u0219i Embriologie) rezultatele ob\u0163inute \u0219i acest criteriu de control a activit\u0103\u0163ii trebuie s\u0103 fie bun criteriu de acreditare a oric\u0103rui Centru de FIV.<\/em><\/p>\n

\u00a0<\/strong>Care este situa\u0163ia malpraxisului \u00een Rom\u00e2nia? Este obstetricianul obligat s\u0103 \u00eencheie asigur\u0103ri de malpraxis \u00een compara\u0163ie cu alte specialit\u0103\u0163i? <\/strong><\/p>\n

Din p\u0103cate to\u0163i medicii \u0219i asistentele medicale trebuie s\u0103 pl\u0103teasc\u0103 asigur\u0103ri medicale pentru malpraxis. Sume imense colectate de Firmele de Asigur\u0103ri de s\u0103n\u0103tate nu au folosite pentru nici un caz cu acuza\u0163ii de malpraxis.!!<\/em><\/p>\n

Un raport al Inspec\u0163iei Judiciare pentru anul 2017 releva un num\u0103r total de 215 dosare de urm\u0103rire penal\u0103 \u00een desf\u0103\u0219urare \u0219i cu vechime mai mare de doi ani av\u00e2nd ca obiect infrac\u0163iuni contra persoanei ca urmare a culpei medicale. \u00cen 2018 doi medici chirurgic din Slatina au fost condamna\u0163i penal la pedeapsa cu \u00eenchisoare pentru gre\u0219eli medicale, sentin\u0163a fiind \u00eens\u0103 una cu executarea pedepsei.<\/em><\/p>\n

\u00cen anul 2019 a fost infiin\u0163at\u0103 Asocia\u0163ia \u201d\u00cen ap\u0103rarea medicilor (AAM)\u201d, o organiza\u0163ie non-profit care \u00ee\u0219i propune limitarea atragerii r\u0103spunderii penale pentru gre\u0219eli medicale. Trebuie proiecte legislative, trebuie coagularea organiza\u0163iilor profesionale, trebuie dezbateri publice care s\u0103 implice personal medical, juri\u0219ti, magistra\u0163i.<\/em><\/p>\n

Academia Rom\u00e2n\u0103 reprezentat\u0103 de Acad. Victor Voicu a organizat o \u00eent\u00e2lnire cu Pre\u0219edin\u0163ii tuturor Societ\u0103\u0163ilor Profesionale Medicale din Rom\u00e2nia \u0219i \u00eempreun\u0103 cu Asocia\u0163ia \u201d\u00cen ap\u0103rarea medicilor (AAM)\u201d au \u00eenceput demersurile pentru propuneri legislative asem\u0103n\u0103toare cu cele din Comunitatea European\u0103.<\/em><\/p>\n

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\u00a0Care a fost \u0219i care este situa\u0163ia din maternit\u0103\u0163i \u00een pandemia de COVID? A fost \u0219i este o perioad\u0103 foarte intens\u0103 din punct de vedere medical. 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