人工流产后关爱咨询指导对剖宫产术后非意愿妊娠女性避孕行为和心理健康的影响

The effect of post-abortion care counseling and guidance on contraception and mental health of women with unwanted pregnancies after cesarean section

目的探讨人工流产后关爱(PAC)咨询指导对剖宫产术后非意愿妊娠女性的避孕行为和心理健康的影响.方法选择因剖宫产术后2年内发生非意愿妊娠且自愿行人工流产的568例患者,以人工流产后接受PAC咨询指导的346例为观察组、接受无PAC的常规医疗咨询指导的222例为对照组.收集2组患者一般情况、流产方式、人工流产前非意愿妊娠的原因、人工流产前和人工流产1年后采取的避孕措施,以及术后1年内再次非意愿妊娠的情况,并在人工流产前和人工流产2周后采用焦虑自评量表(SAS)评估患者的精神状态.结果2组患者的年龄、妊娠时间、人工流产前剖宫产次数、人工流产距前次剖宫产的时间及流产方式比较差异均无统计学意义(P均>0.05).导致2组患者非意愿妊娠的原因为避孕失败、未避孕和不知晓避孕,2组比较差异无统计学意义(P>0.05).经过不同形式的宣教和指导,观察组与对照组患者在人工流产前与人工流产1年后的避孕方式均有所改变(P均<0.05),观察组中高效避孕者比例高于对照组.人工流产2周后观察组中焦虑者比例低于人工流产前(P<0.05),对照组中焦虑者比例与人工流产前比较差异无统计学意义(P>0.05),观察组中焦虑者比例低于对照组(P<0.05).人工流产1年后,观察组再次非意愿妊娠率低于对照组(P<0.05).结论PAC咨询指导能缓解剖宫产术后非意愿妊娠女性的焦虑情绪,有效提高高效避孕率,降低重复人工流产率.

Objective To study the effect of post-abortion care(PAC)on contraception and mental health of women with unwanted pregnancies after caesarean section.Methods 568 patients who were willing to receive induced abortion due to unplanned pregnancies within 2 years after caesarean section were selected.Among them 346 women receiving PAC counseling and guidance after induced abortion were assigned into the test group,and 222 women receiving routine medical counseling and guidance but not PAC were into the control group.The general conditions,abortion methods,reasons of unwanted pregnancies before induced abortion,and contraceptive measures before and 1 year after induced abortion,and postoperative unwanted pregnancies within 1 year after caesarean section in two groups were collected and compared.The patient mental health before and 2 weeks after induced abortion were assessed by self-rating anxiety scale(SAS).Results The differences of ages,pregnant time,times of caesarean section before induced abortion,gap between the induced abortion and the prior caesarean section,and abortion methods between two groups were not statistically significant(all P>0.05).The reasons of unintended pregnancies in both groups were contraceptive failure,no contraception,and lacking knowledge of contraception.However,there was no significant difference in the proportions of reasons for unwanted pregnancies(P>0.05).After receiving different education and guidance,the contraceptive methods before and 1 year after induced abortion changed(both P<0.05)in both test and control groups.The percentage of patients who had highly effective contraception was higher in the test group than in the control group.In the test group,the proportion of patients with anxiety 2 weeks after induced abortion was lower than before induced abortion(P<0.05).Whereas the proportion of patients with anxiety in the control group had no statistical significance compared with before induced abortion(P>0.05).The proportion of patients with anxiety in the test group was lower than that of the control group significantly(P<0.05).The percentage of patients with unwanted pregnancies within 1 year after induced abortion in the test group was significantly lower than that of the control group(P<0.05).Conclusion PAC counseling and guidance can ease the anxiety of famales with unwanted pregnancies after caesarean section,improve the effective contraception rate,and reduce the rate of repeated induced abortion.