Investigation and analysis of trauma perception and influencing factors in postpartum women undergoing vaginal delivery
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摘要:
目的 调查经阴道分娩产妇分娩创伤感知的现状，并分析其影响因素。 方法 采取便利抽样法，选取2022年2月—2023年1月温州医科大学附属第一医院经阴道分娩产妇为研究对象。采用一般资料问卷、经阴道分娩产妇分娩创伤感知量表、家庭关怀指数量表(APGAR)、分娩态度量表(CAQ)对产妇进行调查，Pearson相关性分析经阴道分娩产妇分娩创伤感知与家庭关怀度、分娩恐惧的关系，经阴道分娩产妇分娩创伤感知的影响因素采用多重线性回归分析。 结果 经阴道分娩产妇分娩创伤感知总得分(81.05±21.41)分，处于中等偏上水平，家庭关怀度总分(8.27±1.06)分，分娩恐惧总得分(38.71±8.49)分；Pearson相关性分析显示，经阴道分娩产妇分娩创伤感知量表总分与APGAR量表总分呈负相关关系(r=-0.286，P < 0.05)，与CAQ量表总分呈正相关关系(r=0.397，P < 0.01)；多重线性回归分析结果显示，产次、产检次数、家庭关怀、孕期宣教次数、分娩恐惧及对经阴道分娩过程的了解均是经阴道分娩产妇分娩创伤感知的影响因素(P < 0.05)，可解释经阴道分娩产妇分娩创伤感知32.5%的方差变异。 结论 经阴道分娩产妇分娩创伤感知处于中等偏上水平，产次、产检次数、家庭关怀、孕期宣教次数、分娩恐惧及对经阴道分娩过程的了解是经阴道分娩产妇分娩创伤感知的影响因素。医护人员应重视产妇的情绪变化，开展多样化有效的产前健康宣教活动，激发产妇积极的心理状态，进而降低产妇分娩创伤感知水平。 Abstract:Objective To investigate the current status of postpartum trauma perception in women undergoing vaginal delivery and analyze its influencing factors. Methods Convenience sampling was used to select postpartum women who underwent vaginal delivery in our hospital from February 2022 to January 2023 as the research subjects. We conducted a survey on postpartum women using a general information questionnaire, the Postnatal Trauma Perception Scale for Vaginal Delivery, the Family Care Index (APGAR), and the Childbirth Attitude Scale (CAQ). Pearson correlation analysis was conducted to investigate the relationship between postpartum trauma perception, family care, and childbirth fear among women who had vaginal delivery. Multiple linear regression analysis was used to investigate the influencing factors of postpartum trauma perception in women undergoing vaginal delivery. Results The total score of trauma perception during vaginal delivery was (81.05±21.41) points, which was above average. The total score of family care was (8.27±1.06) points, and the total score of childbirth fear was (38.71±8.49) points; Pearson correlation analysis showed that there was a negative correlation (r=-0.286, P < 0.05) between the total score of the delivery trauma awareness scale and the total score of the APGAR scale for women undergoing vaginal delivery, and a positive correlation (r=0.397, P < 0.01) with the total score of the CAQ scale. Multiple linear regression analysis showed that parity, frequency of prenatal check ups, family care, frequency of pregnancy education, fear of childbirth, and understanding of the vaginal delivery process were factors affecting the perception of delivery trauma in women undergoing vaginal delivery (P < 0.05), which could explain 32.5% of the variance variation in the perception of delivery trauma in women undergoing vaginal delivery. Conclusion The perception of childbirth trauma among women undergoing vaginal delivery is at a moderate to high level. Factors influencing the perception of childbirth trauma among women undergoing vaginal delivery include parity, frequency of prenatal check-ups, family care, frequency of pregnancy education, fear of childbirth, and understanding of the vaginal delivery process. Medical staff should pay attention to the emotional changes of postpartum women, carry out diversified and effective prenatal health education activities, stimulate their positive psychological state, and thereby reduce their perception of childbirth trauma. -
Key words:
- Vaginal delivery /
- Childbirth trauma /
- Influencing factors /
- Fear of childbirth /
- Family care
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表 1 经阴道分娩产妇分娩创伤感知、家庭关怀度、恐惧得分情况(n=216)
Table 1. Perception of childbirth trauma, family care, and fear scores among women undergoing vaginal delivery (n=216)
项目 条目数 得分范围 得分
(x±s，分)条目均分
(x±s，分)创伤感知总分 31 31~155 81.05±21.41 2.61±0.92 分娩疼痛创伤感知 7 7~35 21.46±7.29 3.06±0.95 分娩结局创伤感知 4 4~20 12.93±5.07 3.23±1.07 医疗支持创伤感知 14 14~60 38.52±14.63 2.75±1.03 家庭支持创伤感知 6 6~30 8.14±3.42 1.36±0.49 APGAR总分 5 0~10 8.27±1.06 1.65±0.31 CAQ总分 16 16~64 38.71±8.49 2.48±0.57 胎儿健康 5 5~20 11.55±0.16 2.31±0.69 自我控制 4 4~16 10.28±0.21 2.57±0.66 产痛伤害 4 4~16 11.88±0.35 2.97±0.61 医疗环境 3 3~12 5.03±0.09 1.67±0.54 
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表 2 不同特征研究对象的分娩产妇分娩创伤感知得分比较(n=216)
Table 2. Comparison of perceived delivery trauma scores among parturients with different characteristics (n=216)
项目 人数[例(%)] 分娩产妇分娩创伤感知总分(x±s，分) 统计量 P值 年龄(岁) 0.445a 0.641 21~30 141(65.28) 83.69±20.54 31~40 59(27.31) 81.55±21.07 >40 16(7.41) 79.42±22.54 产次 3.557b 0.001 初产妇 169(78.24) 86.21±19.54 经产妇 47(21.76) 74.47±21.65 教育程度 0.234a 0.792 高中及以下 48(22.22) 82.36±21.09 专科及本科 112(51.85) 80.47±20.93 研究生及以上 56(25.93) 79.64±20.05 家庭月收入(元) 0.249a 0.779 <3 000 19(8.80) 83.01±21.17 3 000~6 000 103(47.69) 80.87±20.98 >6 000 94(43.52) 79.52±21.46 职业 0.294a 0.729 公司职员 91(42.13) 82.36±21.47 公职人员 45(20.83) 78.86±20.71 技术人员 41(18.98) 80.86±19.93 其他 39(18.06) 81.79±20.94 地域 0.711b 0.478 城市 172(79.63) 79.53±21.24 农村 44(20.37) 82.09±21.63 本次妊娠 -0.806b 0.421 计划 185(85.65) 78.48±22.56 意外 31(14.35) 81.97±20.69 产检次数(次) -4.307b ＜0.001 ≥5 182(84.26) 72.43±19.54 <5 34(15.74) 88.59±22.83 宗教信仰 -0.254b 0.799 有 55(25.46) 80.93±21.67 无 161(74.54) 81.78±21.36 婚姻状况 -0.404b 0.682 已婚 210(97.22) 80.07±20.58 其他(如离异/单身等) 6(2.78) 83.52±21.46 会阴侧是否侧切/撕裂 1.288b 0.199 是 119(55.09) 82.93±20.36 否 97(44.91) 79.25±21.53 希望分娩方式 0.331a 0.718 自然分娩 131(60.65) 79.65±20.17 剖宫产 69(31.94) 82.09±21.63 未考虑 16(7.41) 81.49±20.96 孕期宣教次数 5.633a 0.004 未参加过 13(6.02) 88.96±18.42 1~3次 48(22.22) 81.73±20.69 ≥4次 155(71.76) 72.59±22.84 妊娠并发症 1.866b 0.063 是 41(18.98) 85.73±21.84 否 175(81.02) 78.95±20.73 对经阴分娩过程的了解 -4.072b ＜0.001 了解 182(84.26) 72.54±19.69 不了解 34(15.74) 87.85±22.36 对孩子性别期待 0.619b 0.537 是 57(26.39) 82.31±21.64 无所谓 159(73.61) 80.29±20.96 受孕类型 -0.381b 0.703 自然受孕 204(94.44) 80.17±21.37 人工受孕 12(5.56) 82.59±21.46 家庭关怀度 5.088a 0.007 家庭关怀度差 18(8.33) 87.63±22.06 家庭功能中度障碍 22(10.19) 79.46±20.85 家庭关怀度良好 176(81.48) 72.94±19.62 分娩恐惧 12.916a ＜0.001 高度恐惧 43(19.91) 89.54±22.75 中度恐惧 81(37.50) 83.49±22.13 轻度恐惧 92(42.59) 71.43±19.57 注：a为F值；b为t值。
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表 3 经阴道分娩产妇分娩创伤感知与家庭关怀度、恐惧的相关性分析(r值)
Table 3. Correlation analysis of perceived childbirth trauma, family care, and fear among women undergoing vaginal delivery
项目 分娩疼痛创伤感知 分娩结局创伤感知 医疗支持创伤感知 家庭支持创伤感知 总量表总分 APGAR总分 -0.235a -0.319a -0.292a -0.304a -0.286a CAQ总分 0.416b 0.379b 0.425b 0.362b 0.397b 胎儿健康 0.309b 0.362b 0.353b 0.329b 0.341b 自我控制 0.424b 0.391b 0.327b 0.428b 0.403b 产痛伤害 0.411b 0.349b 0.364b 0.417b 0.386b 医疗环境 0.322b 0.353b 0.371b 0.325b 0.353b 注：aP < 0.05；bP < 0.01。
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表 4 变量赋值
Table 4. Variable assignment
变量 赋值说明 产次 初产妇=0，经产妇=1 产检次数 ≥5次=0， < 5次=1 家庭关怀度 家庭关怀度差=0，家庭功能中度障碍=1，家庭关怀度良好=2 孕期宣教次数 未参加过=0，1~3次=1，≥4次=2 分娩恐惧 轻度恐惧=0，中度恐惧=1，高度恐惧=2 对经阴分娩过程的了解 不了解=0，了解=1
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表 5 经阴道分娩产妇分娩创伤感知影响因素的多重线性回归分析
Table 5. Multiple linear regression analysis of factors influencing the perception of childbirth trauma in women undergoing vaginal delivery
影响因素 B SE β t值 P值 产次 -0.793 0.141 -0.219 -5.624 < 0.001 产检次数 0.672 0.283 0.157 2.345 0.018 家庭关怀度 -4.915 2.178 -0.276 -2.257 0.025 孕期宣教次数 -0.595 0.293 -0.413 -2.031 0.044 分娩恐惧 0.874 0.176 0.296 4.966 < 0.001 对经阴分娩过程的了解 -1.693 0.714 -0.216 -2.371 0.019 注：R2=0.379，调整后的R2=0.325，F=8.718，P < 0.01。
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