孕晚期孕妇健康相关生命质量与选择性剖宫产的关联性研究
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摘要
目的探讨孕晚期孕妇健康相关生命质量(HRQoL)与选择性剖宫产之间的关联。方法以2013年10月-2014年2月于四川大学华西第二医院进行产前检查的孕晚期孕妇为1 361例研究对象,其中选择性剖宫产组634例,阴道顺产组727例。采用《SF-36健康调查量表》评估其HRQoL状况,并通过查阅病历随访追踪妊娠结局。采用Logistic回归分析HRQoL得分与选择性剖宫产之间的关联。结果选择性剖宫产组生理功能(PF)、生理职能(RP)、总体健康感(GH)、生命活力(VT)及情感职能(RE)等维度的得分均低于阴道顺产组(P<0. 05)。选择性剖宫产组躯体健康总评(PCS)得分为(36. 0±7. 5)分,阴道顺产组为(38. 1±7. 2)分,差异有统计学意义(P<0. 05)。选择性剖宫产组精神健康总评(MCS)得分为(53. 7±7. 5)分,阴道顺产组为(53. 8±7. 5)分,差异无统计学意义(P>0. 05)。Logistic回归分析表明,PCS每增加5分,选择性剖宫产的风险降低0. 86倍(95%CI:0. 79～0. 93)。结论孕晚期孕妇HRQoL高低与选择性剖宫产的发生呈负相关,在孕晚期医疗保健过程中,应给予孕妇生理及心理支持,提高孕妇的HRQoL,以降低选择性剖宫产的发生。
Objective To explore the correlation between health-related quality of life(HRQoL) and selective cesarean section in pregnant women during the third trimester of pregnancy.Methods A total of 1 361 pregnant women during the third trimester of pregnancy receiving prenatal examination in West China Second University Hospital,Sichuan University from October 2013 to February 2014 were enrolled,then they were divided into selective cesarean section group(634 women) and vaginal delivery group(727 women).SF-36 was used to evaluate HRQoL,the pregnancy outcomes were followed up by medical record review.Logistic regression model was used to analyze the correlation between HRQoL score and selective cesarean section.Results The scores of physiological function(PF),role physical(RP),general health(GH),vitality(VT),and role emotional(RE) in selective cesarean section group were statistically significantly lower than those in vaginal delivery group(P<0.05).Physical component summary(PCS) scores in selective cesarean section group and vaginal delivery group were(36.0 ±7.5) and(38.1 ±7.2),respectively,there was statistically significant difference between the two groups(P<0.05).Mental component summary(MCS) scores in selective cesarean section group and vaginal delivery group were(53.7±7.5)and(53.8±7.5),respectively,there was no statistically significant difference between the two groups(P>0.05).Logistic regression model showed that the risk of selective cesarean section decreased by 0.86 times when PCS increased 5 points(95% CI:0.79-0.93).Conclusion HRQoL of pregnant women during the third trimester of pregnancy is negatively correlated with selective cesarean section.Physical and psychological support should be given to pregnant women during the third trimester of pregnancy to improve HRQo L and reduce the incidence rate of selective cesarean section.
Objective To explore the correlation between health-related quality of life(HRQoL) and selective cesarean section in pregnant women during the third trimester of pregnancy.Methods A total of 1 361 pregnant women during the third trimester of pregnancy receiving prenatal examination in West China Second University Hospital,Sichuan University from October 2013 to February 2014 were enrolled,then they were divided into selective cesarean section group(634 women) and vaginal delivery group(727 women).SF-36 was used to evaluate HRQoL,the pregnancy outcomes were followed up by medical record review.Logistic regression model was used to analyze the correlation between HRQoL score and selective cesarean section.Results The scores of physiological function(PF),role physical(RP),general health(GH),vitality(VT),and role emotional(RE) in selective cesarean section group were statistically significantly lower than those in vaginal delivery group(P<0.05).Physical component summary(PCS) scores in selective cesarean section group and vaginal delivery group were(36.0 ±7.5) and(38.1 ±7.2),respectively,there was statistically significant difference between the two groups(P<0.05).Mental component summary(MCS) scores in selective cesarean section group and vaginal delivery group were(53.7±7.5)and(53.8±7.5),respectively,there was no statistically significant difference between the two groups(P>0.05).Logistic regression model showed that the risk of selective cesarean section decreased by 0.86 times when PCS increased 5 points(95% CI:0.79-0.93).Conclusion HRQoL of pregnant women during the third trimester of pregnancy is negatively correlated with selective cesarean section.Physical and psychological support should be given to pregnant women during the third trimester of pregnancy to improve HRQo L and reduce the incidence rate of selective cesarean section.
引文
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[13]田丽华.多维度干预对初产妇分娩及剖宫产率的改善效果研究[J].中国医药导报,2014,11(3):131-133.
[14]刘丽.孕产期健康教育对剖宫产率的影响[J].中国妇幼保健,2014,29(23):3739-3741.
[15]张琴.孕妇心理健康状况及其影响因素分析[J].中国妇幼保健,2008,23(8):1064-1066.
[2]National Institutes of Health State-of-the-Science Conference Statement.Cesarean delivery on maternal request[J].Obstet Gynecol,2006,107(6):1386-1397.
[3]Lau Y.The effect of maternal stress and health-related quality of life on birth outcomes among Macao Chinese pregnant women[J].JPerinat Neonatal Nurs,2013,27(1):14-24.
[4]Farr SL,Dietz PM,Rizzo JH,et al.Health care utilisation in the first year of life among infants of mothers with perinatal depression or anxiety[J].Paediatr Perinat Epidemiol,2013,27(1):81-88.
[5]刘朝杰,李宁秀,任晓晖,等.36条目简明量表在中国人群中的适用性研究[J].四川大学学报(医学版),2001,32(1):39-42.
[6]Khan MN,Islam MM,Shariff AA,et al.Socio-demographic predictors and average annual rates of caesarean section in Bangladesh between 2004 and 2014[J].PLo S One,2017,12(5):e0177579.
[7]Oner C,Catak B,Sutlu S,et al.Effect of social factors on cesarean birth in primiparous women:a cross sectional study(social factors and cesarean birth)[J].Iran J Public Health,2016,45(6):768-73.
[8]Symon A.A review of mothers'prenatal and postnatal quality of life[J].Health Qual Life Outcomes,2003,1(1):38.
[9]Haas JS,Jackson RA,Fuentes-Afflick E,et al.Changes in the health status of women during and after pregnancy[J].J Gen Intern Med,2005,20(1):45-51.
[10]Otchet F,Carey MS,Adam L.General health and psychological symptom status in pregnancy and the puerperium:what is normal?[J].Obstet Gynecol,1999,94(6):935-941.
[11]Handelzalts JE,Fisher S,Lurie S,et al.Personality,fear of childbirth and cesarean delivery on demand[J].Acta Obstet Gynecol Scand,2012,91(1):16-21.
[12]Beebe KR,Humphreys J.Expectations,perceptions,and management of labor in nulliparas prior to hospitalization[J].J Midwifery Womens Health,2006,51(5):347-353.
[13]田丽华.多维度干预对初产妇分娩及剖宫产率的改善效果研究[J].中国医药导报,2014,11(3):131-133.
[14]刘丽.孕产期健康教育对剖宫产率的影响[J].中国妇幼保健,2014,29(23):3739-3741.
[15]张琴.孕妇心理健康状况及其影响因素分析[J].中国妇幼保健,2008,23(8):1064-1066.