体外受精-胚胎移植孕妇生存质量、心理压力与分娩倾向的关系

Relationships between quality of life,psychological stress and choice of delivery modes in pregnant women receiving in vitro fertilization and embryo transfer

目的分析体外受精-胚胎移植(IVF-ET)孕妇生存质量和妊娠压力与分娩方式倾向之间的关系,为IVF-ET孕妇提供个体化的专业咨询和社会支持,促使她们选择自然分娩。方法以武汉大学人民医院妇产科就诊的经IVF-ET受孕的单胎初产孕妇48例为研究对象(IVF组),自然受孕单胎初产孕妇48例为对照(对照组),收集一般情况,采用生存质量测定量表简表和妊娠压力量表评估生存质量和心理压力及选择分娩方式倾向。结果 IVF组的剖宫产愿望更强烈,与对照组差异有统计学意义(P<0.01);总健康状况评分、生理领域和心理领域生存质量分均低于对照组,妊娠压力总分和因子2压力得分均显著高于对照组,差异均有统计学意义(P<0.05)。IVF孕妇中≥35岁亚组妊娠压力总分和因子2压力得分、总健康状况均显著高于<35岁亚组,差异均有统计学意义(P<0.05);初中及以下文化亚组的社会关系领域得分明显高于其他文化程度亚组,妊娠压力因子2得分偏低,4种不孕因素亚组间社会关系差异均有统计学意义(P<0.05)。移植次数≥2次亚组的心理领域生存质量得分较低(P<0.05),分娩倾向的选择与妊娠压力总分及因子2压力得分存在显著相关性(P<0.05)。结论 IVF-ET孕妇在生存质量和妊娠压力上与自然受孕者有显著差异,剖宫产倾向更为强烈。围产保健过程中注意心理保健,减轻其妊娠压力,促使IVFET夫妇正确认识和选择自然分娩,对降低剖宫产率具有积极意义。

Objective To analyze the relationships between quality of life,psychological stress and choice of delivery modes in pregnant women receiving in vitro fertilization and embryo transfer（ IVF-ET）,provide individualized professional consultation and social support for these pregnant women,promote spontaneous labor. Methods Forty-eight primiparous women of single pregnancy receiving IVF-ET in Department of Gynecology and Obstetrics,People＇s Hospital of Wuhan University were selected as IVF group,and 48 primiparous women of single pregnancy conceived naturally were selected as control group. The general situation was collected,Quality of Life Brief Scale and Pregnancy Stress Scale was used to evaluate quality of life,psychological stress and choice of delivery modes. Results The desire of pregnant women for cesarean section in IVF group was more stronger,compared with control group,there was statistically significant difference（ P〈0. 01）. The total health score,physical health score,and psychological health score in IVF group were statistically significantly lower than those in control group（ P〈0. 05）. The total score of pregnancy stress and factor 2 stress score in IVF group were statistically significantly higher than those in control group（ P〈0. 05）. In IVF group,the total score of pregnancy stress,factor 2 stress score,and total health score in ≥35-year-old subgroup were statistically significantly higher than those in 35-year-old subgroup（ P〈0. 05）. The score of social relation domain in junior high school and below educational level subgroup was statistically significantly higher than those in other educational level subgroups（ P〈0. 05）. The score of pregnancy stress factor 2 was low,there were statistically significant differences in social relation among four infertile factor subgroups（ P〈0. 05）. The score of psychological domain in transplantation≥2 times subgroup was significantly low（ P〈0. 05）. The choice of delivery modes was significantly correlated with the total score of pregnancy stress and factor 2 score（ P〈0. 05）. Conclusion There are significant differences in life quality and pregnancy stress between pregnant women receiving IVF-ET and pregnant women conceived naturally,the pregnant women receiving IVF-ET had stronger preference for cesarean section. More attention should be paid to psychological health care during perinatal health care to relieve pregnancy stress. Promoting the couples receiving IVF-ET to appropriately understand and choose spontaneous labor is beneficial for reducing cesarean section rate.