歷經非選擇性終止妊娠之婦女的哀傷與創傷後反應及其相關因素

Abstract

懷孕婦女，期待著孕育正常的胎兒。然而，遭遇死產或胎兒異常而接受終止妊娠之孕婦，卻是件突然與震驚的事件，會使該孕婦面臨哀傷與衝擊。本研究目的為瞭解曾歷經接受非選擇性終止妊娠之婦女的哀傷與創傷後反應，及其相關因素。 本研究設計採問卷調查法，研究情境為台北市某私立醫學中心，研究對象為近四年內曾歷經死產或胎兒異常而接受非選擇性終止妊娠之婦女，採立意取樣，共90位。研究工具為結構式問卷，包括：週產期哀傷量表(PGS)及事件衝擊量表(IES)。資料收集依研究對象之決定，採面對面訪談或郵寄問卷。以SPSS for Windows 13.0版之套裝軟體進行分析，包括：百分比、平均數、標準差、t檢定、單因子變異數分析、線性迴歸、多元迴歸分析等。 研究結果顯示，婦女之哀傷得分為80.20±25.82，屬中等程度的哀傷。其分量表以「活躍性哀傷」得分較高，其次為「失望」、「因應困難」，分別得分為31.50±10.29、24.56±9.44、24.19±8.46。相關因素為：宗教信仰、胎兒死亡種類、目前有無子女。此外，研究結果也顯示，婦女在創傷後反應之得分為26.70±14.21，屬重度創傷後反應，60.20%之研究對象得分大於19分（重度創傷後反應）。其分量表以「侵犯性反應」得分較高（14.99±8.52），其次為「逃避性反應」（11.68±7.46）。相關因素為：宗教信仰、胎兒死亡種類、目前有無子女、自覺哀傷程度、哀傷程度、哀傷被接受的程度。 結論：歷經非選擇性終止妊娠之婦女的哀傷程度為中度，創傷後反應為重度。研究結果可以幫助護理人員早期辨識婦女創傷後反應，協助受創後婦女的心理重建工作，並提供相關單位政策的擬定與受創後續追蹤之依據。

Women expect to carry a normal fetus during the pregnancy. However, the occurrence of stillbirth or fetal abnormalities is a sudden and shocked event, which put the pregnant woman received non-selective termination into grief and impact. The purpose of this study was to explore grief and post-traumatic reaction in the women who received non-selective termination and to identify the related factors. With purposive sampling at a private medical center in Taipei, a questionnaire was used to collect data from 90 women who experienced non-selective termination due to stillbirth or fetal abnormalities within four years. The method to carry out this study was using a structural formula questionnaire, which included Perinatal Grief Scale (PGS) and Impact of Event Scale (IES) to which the women were expected to respond face to face or mail the questionnaire. Data was analyzed with SPSS 13.0 statistical software package. Descriptive statistics, t-test, one-way ANOVA, simple regression, and multiple regression were completed. The results about grief revealed that the obtained scores were 80.20±25.82, which suggested that these women had moderate degree of grief. The subscales scored highest by “active grief”, followed by “despair” and “difficulty coping” with scores of 31.50±10.29, 24.56±9.44, and 24.19±8.46, respectively. The related factors were religious belief, the kind of fetal death, and children count. In addition, the results about post-traumatic reaction revealed that the obtained scores were 26.70±14.21, which suggested that these women had severe degree of post-traumatic reaction. 60.20% of these women scored greater than 19 (severe degree of post-traumatic reaction). The subscales scored highest by “intrusion”, followed by “avoidance” with scores of 14.99±8.52, and 11.68±7.46, respectively. The related factors were religious belief, the kind of fetal death, children count, the degree of self-grief, the degree of grief, and the degree of self-grief being recognized. In conclusion, the women received non-selective termination had moderate degree of grief and severe degree of post-traumatic reaction. The results of this study can assist nurses to identify the post-traumatic reaction at the early stage and efficiently help women on mental rehabilitation. Furthermore, the health authority may utilize this study as their reference when comes to the decision of governmental policy in attempting to promote a more advance health care system.