多元共享决策模式对瘢痕子宫再次妊娠分娩方式的影响  

Effects of multiple shared decision⁃making mode on the mode of delivery for pregnancies with scarred uterus

作　　者：周莉莉 翟巾帼[2] 陶杰 周丽花[1] 刘轩田 ZHOU Lili;ZHAI Jinguo;TAO Jie;ZHOU Lihua;LIU Xuantian(Dongguan Maternal and Child Health Care Hospital,Dongguan 523000,China;不详)

机构地区：[1]东莞市妇幼保健院,广东东莞523000 [2]南方医科大学护理学院,广州510000

出　　处：《实用医学杂志》2024年第4期561-565,共5页The Journal of Practical Medicine

基　　金：2021年度广东省教育科学规划高等教育专项(编号:2021GXJK163);中国高校产学研创新基金资助课题-云中大学项目(编号:2022MU042);2023年广东省研究生教育创新计划项目(编号:2023ANLK-018)。

摘　　要：目的探究决策辅助手册联合在线分娩决策支持的多元共享决策模式对瘢痕子宫再次妊娠女性分娩方式的影响。方法选取2019年9月至2022年10月在某三甲医院产检的94例瘢痕子宫再次妊娠女性为研究对象,采用随机数字表法分为观察组与对照组。对照组接受常规孕期宣教,观察组在常规孕期宣教的基础上接受多元共享决策干预。分别对两组分娩决策冲突程度、分娩方式偏好、分娩后决策后悔程度和最终分娩方式进行比较。结果观察组在接受多元共享决策干预后,决策冲突量表得分降低(P<0.001),在分娩方式偏好调查中表示“不确定”的人数减少,选择经阴道生产的人数增加;最终观察组孕妇行剖宫产者30人(68.2%),阴道分娩者14人(31.8%);观察组孕妇对本次分娩决策后悔程度低于对照组(P<0.001)。结论对瘢痕子宫再次妊娠女性开展多元共享决策可降低其决策冲突程度、增强阴道试产意愿并帮助其做出理性科学的分娩决策。Objective To explore the effects of the multiple shared decision⁃making mode using a decision aid manual in conjunction with online labor and delivery decision support on the delivery mode for pregnant women with a scarred uterus.Methods A total of 94 women with scarred uterus who received prenatal care at a tertiary hospital from September 2019 to October 2022 were enrolled and assigned to experimental and control groups using the random number table method.The control group received standard prenatal education,and the experimental group received multiple shared decision⁃making interventions in addition to standard prenatal education.The degree of conflict in decision⁃making for delivery,preference for delivery mode,postpartum decision regret,and the final delivery mode between the two groups were compared,respectively.Results Following the multiple shared deci⁃sion intervention,decision conflict scores in the experimental group were significantly reduced(P<0.001).In the survey on delivery mode preferences,there was a reduction in the number of individuals in the experimental group expressing"uncertainty",and an increase in those choosing vaginal delivery.Ultimately,in the experimental group,30 women(68.2%)underwent cesarean sections,and 14(31.8%)had vaginal deliveries.The level of post⁃decision regret in the experimental group was lower than that in the control group(P<0.001).Conclusions Multiple shared decision⁃making for women pregnant with a scarred uterus could reduce the level of decision⁃making conflict,increase the willingness for vaginal delivery,and assist them in making rational and scientifically informed decisions regarding childbirth.

关 键 词：瘢痕子宫 共享决策 决策辅助工具 选择性再次剖宫产 剖宫产术后再次妊娠阴道试产 

分 类 号：R473.71[医药卫生—护理学]