分娩恐惧和产前焦虑对分娩过程及结局的影响

Effect of parturition fear and antenatal anxiety on delivery process and outcome

目的研究分娩恐惧及产前焦虑对产妇分娩过程及结局的影响。方法选取2017年1月至2018年6月于我院分娩的218例初产妇作为研究对象,分别使用焦虑自评量表(SAS)及分娩恐惧量表(CAQ)对产妇产前焦虑及分娩恐惧情况进行评估和分组;统计产妇各产程用时、中转剖宫产、缩宫素使用、新生儿Apgar评分等指标。结果不同恐惧程度产妇第一产程用时比较,差异具有统计学意义(F=4.05,P<0.01);不同焦虑程度产妇第一产程用时比较,差异具有统计学意义(F=4.29,P <0.01)。产妇第一产程用时与SAS评分和CAQ评分呈显著正相关(r=0.732、0.778;P<0.05)。恐惧组和焦虑组产妇的转剖宫产、产钳助产、会阴侧切、缩宫素使用的总占比高于无恐惧组和无焦虑组(P<0.05);恐惧组和焦虑组的新生儿1 min Apgar评分<7分占比高于无恐惧组和无焦虑组(P<0.05)。结论初产妇分娩恐惧及产前焦虑的发生率均较高,焦虑及恐惧心理会延长第一产程时间,且其与不良心理反应程度呈正相关,同时会增加中转剖宫产等不良事件的发生,提示临床应重视产妇的产前心理状况,提前进行心理干预。

Objective To study the effect of parturition fear and antenatal anxiety on delivery process and outcome.Methods From January 2017 to June 2018, 218 primiparas who delivered in our hospital were selected as study objects.The antenatal anxiety and parturition fear of primiparas were assessed and grouped by self-rating anxiety scale(SAS) and childbirth attitude questionnaire(CAQ) respectively. The duration of labors, conversion to cesarean section, oxytocin use,Apgar score of newborns and other indicators were counted. Results There were significant differences in the duration of the first stage of labor among primiparas with different levels of fear(F=4.05, P<0.01);there were significant differences in the duration of the first stage of labor among primiparas with different levels of anxiety(F =4.29, P <0.01). There were significant positive correlation between the duration of the first stage of labor and SAS score and CAQ score(r =0.732,0.778;P <0.05). The total rate of measures such as conversion to cesarean section, parturient forceps assisted delivery,perineum lateral resection, oxytocin use in the fear group and anxiety group were higher than those in the non-fear group and non-anxiety group(P<0.05). The proportions of the neonatal 1 min Apgar score<7 in the fear group and anxiety group were higher than those in the non-fear group and non-anxiety group, and the differences were statistically significanty(P<0.05). Conclusion The incidences of parturition fear and antenatal anxiety in primiparas are high. Anxiety and fear will prolong the time of the first stage of labor and have a positive correlation with the degree of adverse psychological reaction.At the same time, the incidence of adverse events such as conversion to cesarean section will increase. The results suggest that clinical attention should be paid to antenatal psychological status of primiparas and psychological intervention should be carried out in advance.