剖宫产术后再次妊娠孕妇在不同时期的分娩方式选择意愿调查  

Survey of selection of delivery mode in pregnant women during different stages of pregnancy after cesarean

作　　者：陈爱月[1] 李婕[1] 王冬妮[1] 何善阳[1] 刘立群[1] 

机构地区：[1]中山大学附属第一医院东院妇产科,广州510735

出　　处：《新医学》2017年第5期354-359,共6页Journal of New Medicine

基　　金：黄埔区应用基础研究计划项目(2014ABS0000544)

摘　　要：目的调查剖宫产术后再次妊娠孕妇在妊娠早、中、晚期对分娩方式的认知程度,探索其健康教育管理模式。方法纳入既往有1次子宫下段横切口剖宫产史及2次分娩间隔≥18个月的单胎孕妇共496例,在产科门诊展开面对面问卷调查。分别调查孕8~12周(妊娠早期)、24~28周(妊娠中期)及37周或以上(妊娠晚期)时孕妇的分娩知识来源、希望选择的分娩方式、对阴道分娩的焦虑因素等,并记录孕妇最终分娩方式。结果最终获取有效问卷388例。孕妇在妊娠早期的分娩知识主要来源于自身经验及网络(36.6%)。随孕周增加,分娩知识来源于产科医师宣教的比例逐渐增加,妊娠晚期达49.7%。92.8%孕妇参与过孕妇学校课程,仅11.9%(46/388)参加过6~8次。随妊娠时间延长,选择剖宫产者比例减少,选择阴道分娩者比例增加(P均<0.017)。在妊娠早、中、晚期,希望剖宫产孕妇对阴道分娩焦虑的主要因素均为担忧子宫破裂者和影响夫妻生活者,与希望阴道分娩孕妇比较差异均有统计学意义(P均<0.017)。希望阴道分娩孕妇在妊娠晚期的担忧子宫破裂、试产失败者比例均低于妊娠早期(P均<0.017)。希望剖宫产孕妇在妊娠中、晚期的恐惧疼痛、担忧子宫破裂者比例均低于妊娠早期,在妊娠中期担忧试产失败者比例低于妊娠早期(P均<0.017)。388例孕妇中,剖宫产术后再次妊娠阴道试产成功率为74.1%。结论随着孕周增加,产科医师宣教逐渐成为孕妇分娩知识的主要来源,阴道分娩焦虑因素减少,阴道分娩意愿上升。Objective To investigate the cognition of delivery mode in pregnant women during the early, middle and late stages of pregnancy after cesarean, aiming to explore a novel mode for health and educa-tion management. Methods A total of 496 pregnant women who underwent once cesarean with transverse inci-sion on the lower uterine segment or with an interval ≥18 months between twice singleton pregnancies were re-cruited in this investigation. Face-to-face questionnaire survey was administered at the obstetrics outpatient. The source of delivery knowledge, the preferred delivery mode and the factors of vaginal delivery anxiety were investigated in pregnant women of gestational 8-12 week （the first trimester of pregnancy） , 24-28 weeks （the second trimester of pregnancy） and ≥ 37 weeks （the third trimester of pregnancy）. Meantime, the actual de-livery mode of each pregnant woman was recorded. Results In total, 388 valid questionnaires were collected. During the first trimester of pregnancy, the source of delivery knowledge mainly originated from their experience and internet （36. 6%） . Along with the increasing gestational age, the source of delivery knowledge was ob-tained from the propaganda and education by obstetricians with a percentage of 49. 1% during the third trimes-ter of pregnancy. Among them, 92. 8% of pregnant women attended the school courses, whereas only 11. 9% （46/388） participated in the courses for 6-8 times. Along with the pregnancy, the percentage of selection ofcesarean was decreased, whereas the proportion of choosing vaginal birth was increased （ both P 〈0. 017 ） . During the first, second and third trimester of pregnancy, pregnant women who chose cesarean were anxious a-bout the risk of uterine rupture and influencing sexual life, significantly differing from those who selected vagi-nal birth （ all P〈0. 017）. During the third trimester of pregnancy, the percentage of women who chose vaginal birth and were concern about uterine rupture a

关 键 词：剖宫产术后 阴道分娩 意愿 宣教 

分 类 号：R473.71[医药卫生—护理学]