臺灣多胞胎妊娠婦女於接受減胎術之決策歷程

Abstract

減胎手術指將多胞胎妊娠的胎兒總數減少的過程。當懷三胎或四胎(高胎數)時，會造成流產、死胎的危險機率上升且對胎兒造成永久性的傷害，多胞胎妊娠會增加母體及胎兒的合併症，醫療上建議減胎。 本研究目的係探討多胞胎婦女面對減胎術決策的過程與產前憂鬱程度。以立意取樣方式在台北市某婦產專科診所，進行多胞胎婦女面對減胎時之決策因素問卷調查，共收取112位個案。研究工具為結構式問卷，內容包括研究對象基本屬性、懷孕經驗、減胎決策量表、愛丁堡周產期憂鬱量表。使用統計方式包括獨立樣本t檢定、單因子變異數分析、皮爾森相關係數。 研究結果發現： 1.研究對象基本屬性與懷孕經驗在決策因素量表分析並無顯著差異，僅是否育有小孩在身體負荷方面考量、多胞胎兒的生命及健康品質、家庭及社會負擔、獲得減胎相關資訊、如何增強內心自我力量在統計上具顯著差異(p< .05)。 2.研究對象基本屬性與懷孕經驗在愛丁堡周產期憂鬱量表分析，發現流產經驗及職業類別具有顯著性(p< .05)，有流產經驗總分較無流產經驗者高，職業類別以家庭主婦高於職業婦女。 3.以愛丁堡周產期憂鬱量表14分為憂鬱的分割點，26%的多胞胎孕婦有憂鬱情形。 本研究結果可協助產科護理人員了解多胞胎孕婦在面對減胎時影響其決策因素及孕期憂鬱程度，並作為提供孕婦健康照護之參考。

Multifetal pregnancy reduction (MFPR) is a procedure used to reduce the number of fetuses in a multiple pregnancy. When a pregnancy involves three or more fetuses (high-order pregnancy), the risks of miscarriage, stillbirth, and lifelong disability increase with each additional fetus. A result that the multiple gestation will cause the medical risk of fetus(es) and mother, fetal reductions are recommended. This research aimed to discover the relationship between decision-making process of MFPR and degree of depression in pregnancy. 112 subjects were recruited using structured questionnaires from an obstetric clinic in Taipei. The structured questionnaire includes the demographic background, Pregnancy experience, Reduction of Decision-making Scale, and Edinburgh Perinatal Depression Scale (EPDS). Statistical Analysis includes the t-test, one-way ANOVA test, and Pearson correlation. The results suggested Decision-making Factor Scale of MFPR was not statistically significant in demographic background and pregnancy experience. However, it was significantly different (p< .05) in the subject whether raising children as body burden, wellness of fetus, household and social issues, collecting fetal reduction information, and how to enhance self-mental strength. The EPDS showed abortion experiences and occupations types statistically significant different (p< .05). The EPDS score of women with previous abortion were higher than no abortion, and unemployment were also higher than career women. Using the EPDS cutoff score of 14 and above as a score indicative of depression, 26% of subjects were classified as depressed with fetal reduction. The research results provide evidence information that influence decision-making factor of MFPR and the depression of pregnancy, and facilitate the development of appropriate health care.