瘢痕子宫再次妊娠孕产妇围生期心理状况的影响因素分析

Factors influencing the psychological conditions of perinatal women with a scarred uterus

目的调查瘢痕子宫再次妊娠孕产妇围生期心理状况的影响因素。方法选取2017年4月至8月在杭州市第一人民医院产科门诊建立围产期保健卡的≥28周的符合纳入标准的剖宫产术后瘢痕子宫再次妊娠孕产妇294例,采用孕产妇基本资料调查表、妊娠相关焦虑量表、抑郁自评量表、爱丁堡产后抑郁量表在孕产妇妊娠28周、32周、36周及产后1周调查她们的焦虑、抑郁水平,分析其影响因素。结果①妊娠28周:瘢痕子宫再次妊娠孕产妇焦虑的影响因素包括不良妊娠经历(OR=2.71,95%CI:1.20~6.14)、身边朋友有无剖宫产术后再次妊娠时发生不良妊娠结局的经历(OR=4.61,95%CI:2.11~10.08);抑郁的影响因素包括职业(OR=1.66,95%CI:1.03~2.38)。②妊娠32周:焦虑的影响因素包括不良妊娠经历(OR=2.74,95%CI:1.20~6.25)、身边朋友有无剖宫产术后再次妊娠时发生不良妊娠结局的经历(OR=3.37,95%CI:1.57~7.27);抑郁的影响因素包括对婚姻生活是否满意(OR=0.17,95%CI:0.05~0.55)、对妊娠分娩相关知识了解程度(OR=1.73,95%CI:1.19~2.51)。③妊娠36周:焦虑的影响因素包括不良妊娠经历(OR=3.62,95%CI:1.55~8.43)、身边朋友有无剖宫产术后再次妊娠时发生不良妊娠结局的经历(OR=2.94,95%CI:1.36~6.34);抑郁的影响因素包括不良妊娠经历(OR=3.40,95%CI:1.47~7.85)、身边朋友有无剖宫产术后再次妊娠时发生不良妊娠结局的经历(OR=2.82,95%CI:1.32~6.04)、对妊娠分娩相关知识的了解程度(OR=1.62,95%CI:1.08~2.45)。④产后1周:焦虑的影响因素包括不良妊娠经历(OR=3.72,95%CI:1.54~9.01)、身边朋友有无剖宫产术后再次妊娠时发生不良妊娠结局的经历(OR=3.82,95%CI:1.71~8.56)、对妊娠分娩相关知识的了解程度(OR=1.66,95%CI:1.09~2.51);抑郁的影响因素是对妊娠分娩相关知识了解程度(OR=0.42,95%CI:0.26~0.69)。结论临床医护人员应该根据瘢痕子宫再次妊娠孕产妇围生期心理状况及影响因素,针对性地设置孕妇学校课程,引导孕产妇以良好的身心状态对待妊娠,以期全面提高出生人口素质。

Objective To explore the factors influencing the psychological conditions of perinatal women with a scarred uterus.Method Longitudinal study was used in this research.294 pregnant women set up a perinatal health card in the outpatient department of the Affiliated Hangzhou First People’s Hospital for a period from April to August,2017.P-RAQ,S-AI,EPDS were used to investigate the states of anxiety and depression of perinatal women with a scarred uterus at maternal perinatal periods of 28 weeks,32 weeks,36 weeks and One week after delivery.Results Univariate analysis showed that the risk factors for anxiety of pregnant women with a scarred uterus at 28 weeks of perinatal period include adverse pregnancy experience(OR=2.71,95%CI:1.20-6.14),experience of adverse pregnancy outcomes of friends with a procedure of cesarean section previously(OR=4.61,95%CI:2.11-10.08);the risk factors for depression include occupation(OR=1.66,95%CI:1.03-2.38).At 32 weeks,the risk factors for anxiety include adverse pregnancy experience(OR=2.74,95%CI:1.20-6.25),friends’ experience of adverse pregnancy outcomes with a procedure of cesarean section previously(OR=3.37,95%CI:1.57-7.27);the risk factors for depression include satisfaction of married life(OR=0.17,95%CI:0.05-0.55),knowledge of pregnancy and labor(OR=1.73,95%CI:1.19-2.51).At 36 weeks,the risk factors for anxiety include adverse pregnancy experience(OR=3.62,95%CI:1.55-8.43),friends’ experience of adverse pregnancy outcomes with a procedure of cesarean section previously(OR=2.94,95%CI:1.36-6.34);the risk factors for depression include adverse pregnancy experience(OR=3.40,95%CI:1.47-7.85),friends’ experience of adverse pregnancy outcomes(OR=2.82,95%CI:1.32-6.04),knowledge of pregnancy and labor(OR=1.62,95%CI:1.08-2.45).At the first week after delivery,risk factors for anxiety include adverse pregnancy experiences(OR=3.72,95%CI:1.54-9.01),and friends’ experience of adverse pregnancy outcomes with a procedure of cesarean section previously(OR=3.82,95%CI:1.71-8.56),knowledge of pregnancy and labor(OR=1.66,95%CI:1.09-2.51);The risk factors for depression include knowledge of pregnancy and labor(OR=0.42,95%CI:0.26-0.69) Conclusion The medical professionals are expected to provide guide courses for perinatal pregnant women with a scarred uterus according to their psychological state and the risk factors foranxiety and depression to guide them to maintain a healthy state of body and mind to improve the quality of the population.