新医学2017，Vol.48Issue(5)：354-359,6.DOI:10.3969/j.issn.0253-9802.2017.05.015
剖宫产术后再次妊娠孕妇在不同时期的分娩方式选择意愿调查
Survey of selection of delivery mode in pregnant women during different stages of pregnancy after cesarean
摘要
Abstract
Objective To investigate the cognition of delivery mode in pregnant women during the early, middle and late stages of pregnancy after cesarean, aiming to explore a novel mode for health and education management. Methods A total of 496 pregnant women who underwent once cesarean with transverse incision on the lower uterine segment or with an interval ≥ 18 months between twice singleton pregnancies were recruited in this investigation. Face-to-face questionnaire survey was administered at the obstetrics outpatient. The source of delivery knowledge, the preferred delivery mode and the factors of vaginal delivery anxiety were investigated in pregnant women of gestational 8-12 week (the first trimester of pregnancy), 24-28 weeks (the second trimester of pregnancy) and ≥ 37 weeks (the third trimester of pregnancy). Meantime, the actual delivery mode of each pregnant woman was recorded. Results In total, 388 valid questionnaires were collected. During the first trimester of pregnancy, the source of delivery knowledge mainly originated from their experience and internet (36.6%). Along with the increasing gestational age, the source of delivery knowledge was obtained from the propaganda and education by obstetricians with a percentage of 49.7% during the third trimester of pregnancy. Among them, 92.8% of pregnant women attended the school courses, whereas only 11.9% (46/388) participated in the courses for 6-8 times. Along with the pregnancy, the percentage of selection of cesarean was decreased, whereas the proportion of choosing vaginal birth was increased (both P<0.017). During the first, second and third trimester of pregnancy, pregnant women who chose cesarean were anxious about the risk of uterine rupture and influencing sexual life, significantly differing from those who selected vaginal birth (all P<0.017). During the third trimester of pregnancy, the percentage of women who chose vaginal birth and were concern about uterine rupture and failed trial of labor was significantly lower compared with that in their counterparts during the first trimester of pregnancy (P<0.017). During the second and third trimester of pregnancy, the percentage of pregnant women choosing cesarean who were concerned about the pain and uterine rupture was significantly lower than that in their counterparts during the first trimester of pregnancy. The proportion of pregnant women who were anxious about the failed labor was significantly lower compared with that in those during the first trimester of pregnancy (both P<0.017). Among 388 pregnant women, 20.6% of them chose vaginal birth, 73.7% selecting cesarean and 5.7% switching to cesarean after failed vaginal birth. The success rate of trial of labor after cesarean (TOLAC) was 74.1%. Conclusions Along with the increasing gestational age, propaganda and education by obstetricians have become a pivotal source of delivery knowledge for pregnant women. The factors related to vaginal birth anxiety are decreased and the willingness to choose vaginal birth is elevated. Obstetricians should provide effective propaganda and education for the pregnant women, encourage them to be confident about TOLAC, enhance the willingness to choose TOLAC and attempt to reduce the cesarean rate.关键词
剖宫产术后/阴道分娩/意愿/宣教Key words
Cesarean/Vaginal birth/Intention/Propaganda and education引用本文复制引用
陈爱月,李婕,王冬妮,何善阳,刘立群..剖宫产术后再次妊娠孕妇在不同时期的分娩方式选择意愿调查[J].新医学,2017,48(5):354-359,6.基金项目
黄埔区应用基础研究计划项目(2014ABS0000544) （2014ABS0000544）
