凶险性前置胎盘伴胎盘植入行剖宫产手术产妇真实体验的质性研究

A qualitative study on the real experience of parturients with pernicious placenta previa and placenta increta undergoing cesarean section surgery

目的探讨凶险性前置胎盘伴胎盘植入行剖宫产手术产妇从确诊至分娩后的真实体验,以期为临床治疗和护理决策提供理论依据。方法本研究为质性研究。采用目的抽样法,选取2022年11月—2023年1月在郑州大学第一附属医院产科住院的13名凶险性前置胎盘伴胎盘植入行剖宫产手术产妇进行半结构深度访谈。收集整理访谈资料,采用Colaizzi 7步分析法对资料进行分析,了解凶险性前置胎盘伴胎盘植入行剖宫产手术产妇的经历和真实体验。结果凶险性前置胎盘伴胎盘植入行剖宫产手术产妇真实体验共提炼出3个主题和12个亚主题。主题一为求医经历坎坷,内心体验曲折复杂(亚主题包括诊断初期的未知与恐惧;面对医疗决策时难以抉择的纠结;艰辛的保胎之路;经历围手术期身心之痛;绝处逢生后的庆幸喜悦;对新生儿及崭新家庭格局的担忧);主题二为孕产过程中的个人积极应对体验(亚主题包括积极寻找疾病相关信息,寻求专业支持;迅速转变角色,完成角色适应;唤起以往经验,体现出坚韧的经产妇特质);主题三为有效利用家庭社会支持(亚主题包括对就诊机构信任依从,满足疾病诊疗需求;接受医护人员专业辅导,消除负性心理,满足知识需求;受益于配偶和家人支持,满足生活和情感需求)。结论凶险性前置胎盘伴胎盘植入行剖宫产手术产妇在孕产过程中能够积极应对疾病,但仍存在不良情绪。医护人员应及时预见潜在风险,为孕产妇及其家属提供正确的信息、专业的指导和帮助,消除孕产妇负性心理。

Objective To explore the real experience of parturients with pernicious placenta previa and placenta increta undergoing cesarean section from diagnosis to childbirth,so as to provide theoretical basis for clinical treatment and nursing decision-making.Methods This study was a qualitative study.From November 2022 to January 2023,purposive sampling was used to select 13 parturients with pernicious placenta previa and placenta increta in the Department of Obstetrics of the First Affiliated Hospital of Zhengzhou University for semi-structured in-depth interviews.After collecting and organizing interview data,the Colaizzi 7-step analysis method was used to analyze the data,in order to understand the real experiences of parturients with pernicious placenta previa and placenta increta undergoing cesarean section.Results The real experience of parturients with pernicious placenta previa and placenta increta undergoing cesarean section was extracted into three themes and 12 sub-themes.The first theme was the difficulties in seeking medical advice,with a complex and tortuous inner experience(the sub-themes include the unknown and fear in the early stages of diagnosis,the difficult struggle to make medical decisions,the arduous journey to protect the fetus,the physical and mental pain during the perioperative period,the joy of being born in a desperate situation,and concerns about the newborn and the new family pattern).The second theme was the personal positive coping experience during pregnancy and childbirth(the sub-themes include actively seeking disease information and professional support,quickly changing roles and completing role adaptation,evoking past experiences and reflecting resilient multipara traits).The third theme was to effectively utilize family social support(the sub-themes include trust and compliance with medical institutions to meet disease diagnosis and treatment needs,receiving professional guidance from medical and nursing staff to eliminate negative psychology and meet knowledge needs,benefiting from spouse and family support to meet life and emotional needs).Conclusions Parturients with pernicious placenta previa and placenta increta undergoing cesarean section can actively cope with the disease during pregnancy and childbirth,but still have negative emotions.Medical and nursing staff should promptly anticipate potential risks,provide correct information,professional guidance,and assistance to pregnant and postpartum women and their families,and eliminate their negative psychology among them.