剖宫产术后再次妊娠孕妇阴道试产风险决策的调查研究

Risk Decision-Making of Vaginal Delivery Trial in Pregnant Women with Second Pregnancy after Cesarean Section

目的探讨剖宫产术后再次妊娠孕妇阴道试产风险决策现状及其影响因素。方法采用简单随机抽样法抽取贵阳市3所三级甲等医院,再通过便利抽样法从该3所医院抽取剖宫产术后再次妊娠的432例孕妇为研究对象,采用自行设计的《剖宫产术后再次妊娠孕妇阴道试产风险决策现状调查问卷》对其进行调查。结果剖宫产术后再次妊娠孕妇对本次妊娠分娩方式的决策倾向得分为(3.79±1.17)分,年龄、居住地、家庭人均月收入、既往阴道分娩史及医生对分娩方式的建议是剖宫产术后再次妊娠孕妇决策阴道试产的影响因素(均P<0.05);相关性分析显示,阴道试产感知风险、风险倾向与分娩方式决策间存在不同程度的相关性(均P<0.01);Bootstrap检验显示,风险倾向对分娩方式决策的中介效应值为0.108(P<0.05),95%CI(0.062,0.162),中介效应与总效应之比比值为0.13。结论年龄越小、居住地为乡镇和农村、家庭人均月收入越低、有阴道分娩史、医生没建议分娩方式和医生建议阴道分娩的孕妇更倾向于决策阴道试产;阴道试产感知风险越低和风险倾向越高的孕妇更倾向选择阴道试产,且风险倾向在阴道试产感知风险和分娩方式决策之间具有部分中介作用。

Objective To investigate the status and influencing factors of vaginal delivery trial risk decision-making of pregnant women with second pregnancy after cesarean section.Methods Totally 432 pregnant women who with second pregnancy after cesarean section were selected from three hospitals in Guiyang city by simple random sampling method,and then investigated by the self-designed questionnaire on the risk decision of vaginal trial of pregnant women with second pregnancy after cesarean section.Results Age,place of residence,average monthly income of family,previous vaginal delivery history and doctor’s advice on delivery mode were the influencing factors of women’s decision-making on vaginal delivery after cesarean section(all P<0.05).The results of correlation analysis showed that the perceived risk and risk tendency of vaginal trial were correlated with the decision-making of delivery mode(all P<0.01);bootstrap test showed that the mediating effect of risk tendency on the decision-making of delivery mode was 0.108(P<0.05),95%CI(0.062,0.162),and the ratio of mediating effect to total effect was 0.13.Conclusions Pregnant women who are younger,live in towns and villages,have lower monthly income per capita,have a history of vaginal delivery,doctors do not recommend delivery methods and doctors recommend vaginal delivery are more likely to make vaginal delivery.The lower the perceived risk of vaginal trial and the higher the risk tendency,the more likely the pregnant women are to choose vaginal trial,and the risk tendency has a partial mediating role between the perceived risk of vaginal trial and the decision-making of delivery mode.