Exploring the Reproductive Decision-Making Process of Family with Fetal Sex Chromosome Abnormalities by Amniocentesis
|Keywords:||性染色體異常;羊膜穿刺;生育決策;個案研究法;Sex chromosome abnormalities;amniocentesis;reproductive decision-making;case study.||Issue Date:||2010||Abstract:||
Since 1985, the Genetic Health Law has provided the amniocentesis examination to advanced maternal age and suspected of babies with congenital defect for the families to understand babies’ health conditions. According to the Department of Health report in 2002, there were 18% sex chromosome abnormalities from abnormal results of amniocentesis. Sex chromosome abnormalities are often not fatal and even completely no symptoms; hence, to make a decision of whether keeping the fetus or not during the limited prenatal time becomes the most difficult choice of the client’s family. This study aimed to explore the reproductive decision-making process of family that the amniocentesis result was fetal sex chromosome abnormalities by the case study method, developed the reproductive decision-making process theory further, proposed suggestions of genetic counseling, and helped the families that the amniocentesis results were fetal sex chromosome abnormalities to make a reproductive decision.
The adopted case study depended on the theoretical propositions and time series strategy, and the decision tree was used to analyze the reproductive decision-making process of family that the amniocentesis result was fetal sex chromosome abnormalities. The research collected the cases at the genetic counseling outpatient clinic of the obstetrics and gynecology department at a medical center in Southern Taiwan; the outpatient clinic had 43 cases of amniocentesis sex chromosome abnormalities during 2004~2009, there were 16 cases terminating the gestation, and the rate was 37.2%. The researcher solicited consent of 13 families from these 43 families, eventually obtained 4 families’ agreement to participate in the research, and the retrospective study and diversified way were utilized to collect the relevant data of the case families’ making the reproductive decision. The research gathered 17 pieces of field study records, 6 pieces of verbatim script, and established 4 case databases. Among the 4 families’ data analyses, the prenatal amniocentesis results and reproductive decision-making process themes of the families that decided to continue the pregnancy were “45, X〔8〕/46, XX〔30〕--searching for the fetus’ proof of being healthy, and not giving up easily” and “47, XXY—being not hardhearted enough to end a new life, and steadying the faith from professional consultation” respectively; the prenatal amniocentesis results and reproductive decision-making process themes of the families that decided to terminate the pregnancy were “47, XXX—needing a really great courage to undertake the future challenge” and “47, XYY—hoping that the baby does not lose at the starting point” respectively.
From replication logic, it was found that each case constantly confirmed the fetus’ health condition through the process of seeking medical advice and consultation, and via the internet to search the information. Under the scenario of pregnancy, depending on the personal value and belief and the decision-making experience in the past, and under the influences of family, society and culture, gradually sketched the contours of the child’s appearance that could accept, and made the final reproductive decision after measuring “the fetus’ health condition” and “the acceptable child’s appearance.” The research made the medical staff be able to empathize the families’ reproductive decision-making course, and analyzed the medical staff’s influence on the client’s family’s cognition of confirming the fetus’ health condition; the research’s suggestion is to do the genetic counseling with a neutral attitude, provide amply information to assist the client’s family to make the decision, and establish Taiwan’s tracing system of families that the amniocentesis results are fetal sex chromosome abnormalities in order to elevate the genetic counseling quality.
|Appears in Collections:||分子醫學研究所|
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