孕妇临产前焦虑、抑郁及其影响因素分析

目的:探讨孕妇产前心理状况及影响因素,为产前心理健康教育和心理咨询提供依据。方法:采用焦虑自评量表(SAS)和抑郁自评量表(SDS)作为测评工具,对368名临产前孕妇进行焦虑、抑郁情绪测定,并分析年龄、文化程度、职业和经济收入等因素对孕妇焦虑、抑郁状况的影响。结果:孕妇临产前焦虑发生率为25.54%,抑郁发生率19.84%;与孕妇年龄、文化程度及职业有关(P<0.05);经济水平对孕妇焦虑、抑郁发生率影响无明显关系(P>0.05)。结论:年龄、文化程度和职业对孕妇产前焦虑、抑郁状况有影响;应有针对性地对孕妇开展产前心理卫生健康教育和心理咨询工作。     

产后抑郁症及其相关因素的分析

目的 探讨产后抑郁症的临床特点及危险因素。以提高产科医师对产后抑郁症的认识,及早采取预防和治疗措施。方法 应用抑郁自评量表、焦虑自评量表、汉姆顿抑郁量表及自制问卷调查表,对２１０例产妇进行产后抑郁症及其相关因素的调查。结果 （１）产后抑郁症的发生率为３７．１４％（７８／２１０）,其中轻型为９１．０３％（７１／７８）,中型为８．９７％（７／７８）。生活空虚感、思维困难感、决断困难感、能力减退感、无用感和绝望感这６个症状,是产后抑郁症妇女最多见的主诉。１０．４８％（２２／２１０）的产妇患有焦虑症状。（２）产妇不良的处世表现、情绪控制差、分娩前的心理准备不足及分娩知识的掌握不够等社会心理因素与抑郁症发生有关,是产后抑郁症发生的危险因素。结论 （１）产后抑郁症在围产期妇女中具有较高的发生率,是产妇常见的精神及心理障碍。     

孕妇发生产前抑郁的相关因素研究

目的：探讨影响孕期抑郁的社会心理危险因素，为针对性的开展孕期教育、孕期心理指导及中医药干预提高理论依据。方法：于2011年9月至2012年5月期间在泰安地区随机选用孕35周以上的孕妇共564名进行调查，填写应用社会支持量表（SSQ）和相关社会心理因素调查表。应用SPSS17．0统计软件进行分析。结果：在调查的孕妇中出现抑郁症状者195名（34．5％），其中轻度抑郁症状的113名（20．O％），中度抑郁者82名（14．5％），重度抑郁者4名（O．7％）；无固定职业的产妇及农村户口产妇出现抑郁症状的可能性略高于有职业的、城市户口的产妇（P〈O．05）；年龄相对较大的产妇（超过30岁）和单独居住产妇出现焦虑症状的可能性较高（P〈O．01）。经济、家庭、对胎儿性别的关心、个人不良生活习惯等因素均可影响产妇抑郁、焦虑状况的发生。     

89例孕妇产前焦虑及调查分析

目的：为掌握孕妇产前心理状况及影响因素，为孕产妇产前进行心理指导和心理咨询提供依据。方法：采用焦虑自评量表（SAS）测评工具和调查问卷的方式，对我院2013年1—10月份间随机抽取的300名孕妇进行调查，结合遗传、年龄、文化程度和经济收入等因素对孕妇焦虑的影响。结果：300名孕妇中，临产前焦虑89名，发生率为29．66％；与孕妇遗传、年龄、文化程度、经济水平有关（P〈0．05）。结论：年龄、文化程度和职业对孕妇产前焦虑状况有影响；应有针对性地对孕妇开展产前心理卫生健康教育和心理咨询工作。     

产妇精神因素对分娩方式及产后出血的影响(附120例临床分析)

目的　观察产妇精神状态（ 焦虑与抑郁） 与分娩方式、产后出血间的关系。方法　１２０ 例健康初产妇以汉密顿焦虑量表（ＨＡＳ） 和抑郁量表（ＨＤＳ） 评定精神状态，所有产妇以产科常规进行分娩而不进行干预，观察其分娩方式及产后出血状况；按分娩方式不同分为剖宫产组、钳产组及顺产组；按产后出血不同分产后出血组及无产后出血组。结果　１２０ 例产妇焦虑发生率３５ ％ ，抑郁发生率２８．３ ％ ，焦虑并抑郁发生率１６．７ ％ 。剖宫产组、钳产组的焦虑评分及抑郁评分明显高于顺产组，而剖宫产组、钳产组间则无显著差异；产后出血组焦虑及抑郁评分亦明显高于无产后出血组。结论　焦虑状态与抑郁状态是增加助产率及产后出血的一个可能因素     

产后抑郁症发病因素的探讨

目的 探讨产后抑郁症的发生率及其影响因素,方法 随机抽取在本院产前门诊初诊并决定在本院分娩的１０５２例孕妇进行医院焦虑及抑郁情绪自评量表调查,其中以艾迪产后抑郁量表（ＥＰＤＳ）跟踪调查至产后７天内共８６６例。结果 ＥＰＤＳ阳性率为１５．０１％（１３０／８６６）,并用单因素和多元逐步回归分析了产后抑郁症的影响因素,发现孕妇健康状况,孕期夫妻关系,分娩时医务人员的态度,丈夫企盼生男孩的程度及孕妇孕期听     

孕产妇性格类型对围产期及产褥期后心理的影响

目的了解孕产妇的性格类型与围产期心理状态的关系，探讨有效的心理干预措施，为孕产妇心理保健工作提供科学依据。方法随机抽取2002年10月至2003年3月在产科门诊就诊的孕妇570例，采用艾森克个性问卷（EPQ）、焦虑自评量表（SAS）、抑郁自评量表（SDS）进行性格、心理状态及其影响因素的调查，对其中216例进行产时心理调查、300例于产后1～5d和产后42～60d跟踪调查。结果将孕产妇性格分为外向稳定、外向不稳定、内向稳定和内向不稳定四种类型，孕期焦虑、抑郁的发生率分别为10．5％、10．2％，产褥早期焦虑、抑郁的发生率分别为4．0％、5．3％，产褥后期与产褥期后抑郁的发生率分别为40．7％、10．0％，外向稳定的性格类型发生心理障碍者较少，内向不稳定性格类型发生心理障碍者较多。结论孕妇性格的稳定性对孕产妇心理状态的影响主要表现在不同性格人群发生心理障碍的几率不同，对高危人群实行重点干预可能减少围产期心理障碍的发生。     

剖宫产与阴道分娩产妇的心理状态分析

剖宫产与阴道分娩产妇的心理状态分析王伶伶，董淑英孕妇分娩过程的顺利程度与其自身心身状态和外环境密切相关，过度紧张的情绪会影响正常分娩。研究剖宫产和阴道分娩孕妇的心理状态和行为表现的差异，是产时心理保健的重要课题。我们应用症状自评量表（ＳＣＬ—９０）￣...     

音乐分娩产前培训对孕妇分娩恐惧及自我效能感的干预研究

目的 观察在孕妇产前培训中实施音乐分娩干预对降低孕妇恐惧感及自我效能感的效果。方法 选取86名接受阴道分娩的孕妇,根据随机抽样法分为两组,各43名。对照组实施常规产前护理教育,观察组在对照组基础上增加音乐分娩产前培训。对比两组孕妇的分娩恐惧量表（CAQ）评分、焦虑、抑郁情绪评分、分娩控制感及自我效能感评分。结果 观察组CAQ评分、焦虑和抑郁情绪评分低于对照组（P<0.05）。观察组分娩控制感及自我效能感评分高于对照组（P<0.05）。结论 在孕妇分娩前开展音乐分娩产前培训工作,有助于改善孕妇的分娩恐惧感,显著提升孕妇自我效能感。     

心理干预在初产妇分娩过程中的运用

目的：探讨心理干预对初产妇分娩的影响。方法：选取60例初产产妇,给予心理干预,包括分娩认知教育、产前心理护理、产时心理护理;选取60例初产产妇进行照组,给予常规护理。结果：干预组与对照相比产妇的产程时间、剖宫产率均显著降低（P〈0．05）,差异具有统计学意义。结论心理干预能减轻其对妊娠和分娩的恐惧,使其做好分娩的心理准备,避免了孕妇盲目选择剖宫产。     

Complexity of parental prenatal attachment during pregnancy at risk for preterm delivery

Objective: To clarify the links between parents’ prenatal attachment and psychosocial perinatal factors such as maternal depression, anxiety and social support.

Methods: Cross-sectional study including 43 couples with high-risk pregnancy (RP) and 37 with physiologic pregnancy (PP). Self-report measures (depression, anxiety, social support and prenatal attachment) are completed by mothers, prenatal attachment questionnaire by fathers.

Results: Depression (p?<?0.001) and state anxiety (p?<?0.001) are higher in RP. Both, maternal and paternal antenatal attachment is significantly lower in RP (p?<?0.001; p?<?0.005) but not related to depression or anxiety. Paternal antenatal attachment is strictly related to the maternal attachment scale in both groups (PP: r?<?0.034; RP: r?<?0.004) and paternal antenatal scores in RP have a negative significant correlation with mothers’ depression (r?<?0.095).

Conclusion: Hospitalized expecting parents at risk of preterm delivery develop less attachment to the fetus and higher levels of anxiety and depression compared to the physiologic pregnancy group. Maternal antenatal attachment is an independent variable related to the diagnosis of a possible preterm delivery. The promotion of prenatal psychological well-being and attachment for future mothers and fathers may serve to improve maternal health practices, perinatal health and neonatal outcome.     

Frequency and practice of prescribing prenatal HIV tests during pregnancy

BACKGROUND: To assess frequency and practices of antenatal HIV testing. METHODS: Cross-sectional study. Site: obstetric units of San Paolo Hospital, Milan (teaching, public, 60 beds, 1500 deliveries/years, reference centre for HIV and pregnancy) and of Sandro Pertini Hospital, Rome (public, urban, 36 beds, 1500 deliveries/year). Participants: parturients consecutively admitted for delivery, in the last three months of 1997. Intervention: interview by a structured questionnaire. Out-comes: frequency and practices of antenatal HIV testing. RESULTS: About 79% of the 500 parturients admitted at the San Paolo Hospital and 57% of the 300 at the Pertini Hospital had been tested for HIV during the current pregnancy (p < 0.001). Overall, in 91% of cases (507/555) the test has been requested by the woman's gynecologist with other antenatal tests. Discussion on HIV testing, infection and pregnancy lasted less than 5 minutes in 92% of San Paolo parturients, and in almost all (99.4%) of the Pertini women. Women in the San Paolo hospital had HIV information available by leaflets in 47% of cases in comparison to 35% of those at the Pertini hospital. CONCLUSIONS: In Italy, HIV testing seems to be routinely included in the management of pregnancy, although the uptake and practices of offering the test seem not always appropriate. The higher uptake and the better practice seem to correlate with the higher involvement of San Paolo hospital in the fields of HIV infection in pregnancy. However, the reported overall 71% of tested parturients suggests that in Italy we are still far away from a universal antenatal HIV testing. Specific guidelines should be issued in order to implement and to uniform universal antenatal HIV testing, and to optimize the management of infected women.     

An increased risk for non allo-immunization related intrauterine fetal death in RhD-negative patients.

OBJECTIVE: To investigate immediate perinatal outcome of RhD-negative patients carrying RhD-positive fetuses who received antenatal Rh immunoglobulin for the prevention of RhD-mediated hemolytic disease of the fetus and newborn. METHODS: A retrospective population-based analysis was conducted comparing pregnancies of all RhD-negative women who received antenatal Rh immunoglobulin prophylaxis (anti-D), to RhD-positive parturients, during the years 1988-2003. All women were RhD-negative without evidence of RhD sensitization. Patients received anti-D during the 28-30th week of pregnancy, and an additional dosage within 72 hours following delivery after confirmation of the newborn's RhD status. RESULTS: Of 145,437 deliveries during the study period, 6.8% were of RhD-negative women (n = 9961). Perinatal mortality rate was significantly higher among the RhD-negative women who received antenatal prophylaxis rhesus immunoglobulin as compared with the controls (17/1000 vs. 12/1000, OR = 1.3, 95%CI 1.2-1.6; p < 0.001). This higher mortality rate was related to a higher rate of intrauterine fetal demise (IUFD) (10/1000 vs. 6/1000, OR = 1.5, 95%CI 1.2-1.9; p < 0.001). The association remained significant after controlling for RhD isoimmunization leading to hydrops fetalis, using the Mantel-Haenszel technique (weighted OR = 1.3; 95% CI 1.1-1.5; p = 0.001). The rate of RhD isoimmunization was 0.6% (n = 58). Using a multivariable analysis with IUFD as the outcome variable, controlling for known confounders for fetal demise, RhD-negative status was an independent risk factor for IUFD. CONCLUSION: RhD-negative women carrying RhD-positive newborns are at an increased risk for IUFD despite Rh immunoprophylaxis.     

Maternal Decisions Regarding Prenatal Diagnosis: Rational Choices or Sensible Decisions?

The premise underlying prenatal testing is that knowing the health status of the fetus will enable expectant parents to make rational reproductive decisions. Accordingly, rational-choice perspectives have informed both counselling protocols and the majority of investigations into the psychological processes involved in making decisions about testing and selective abortion. However, because conditions inherent in the testing situation may not adhere to the basic assumptions of rational choice models, the use of these models may be inappropriate. The individualistic focus of rational choice models may be too narrow to encompass the social and psychological factors relevant to making a decision about testing. In light of these limitations, we make a case for adopting a contextual framework for conceptualizing decisions regarding the use of prenatal testing.     

Plasma progesterone in the umbilical vessels at term—an overview

Summary. This paper reports the results of umbilical cord vein and artery, and maternal peripheral vein plasma progesterone levels in over 300 term human deliveries, individual aspects of which have previously been reported. An attempt was made to assess the fetal status objectively, and the results confirm that cord progesterone levels are correlated with the mode of delivery, the clinical indications for the mode of delivery and the clinical condition of the fetus after delivery. No relation was found to fetal sex, induction of labour or maternal antenatal complications.     

Plasma progesterone in the umbilical vessels at term--an overview

This paper reports the results of umbilical cord vein and artery, and maternal peripheral vein plasma progesterone levels in over 300 term human deliveries, individual aspects of which have previously been reported. An attempt was made to assess the fetal status objectively, and the results confirm that cord progesterone levels are correlated with the mode of delivery, the clinical indications for the mode of delivery and the clinical condition of the fetus after delivery. No relation was found to fetal sex, induction of labour or maternal antenatal complications.     

Utilisation of antenatal services at the Provincial Hospital, Mongomo, Guinea Equatoria

This prospective study was carried out to evaluate the utilisation of antenatal care at the Provincial Specialist Hospital, Mongomo, Guinea Equatoria, paying close attention to the confounding factors affecting effective antenatal care (ANC) delivery. Information was elicited from 200 pregnant women attending the antenatal clinic using a questionnaire. Previous antenatal clinic attendance was high (92.5%). However, with increasing gestation, the percentage of those who never had antenatal care increased. Poor ANC attendance is associated with more abortions and poor obstetric performance. Higher levels of education generally improved ANC attendance, particularly early booking for ANC. Hospital workers, husbands and parents were the greatest influence on ANC attendance. Universal education of the women, improved health education, community involvement and integration of traditional birth attendants (TBAs) are significant suggestions made by the patients for improving the delivery of antenatal care.     

Use of maternal care in a rural area of Zimbabwe: a population-based study

PURPOSE: Our aim was to determine the coverage of antenatal and delivery care and the determinants of non-compliance in a rural area of Zimbabwe in order to improve the quality and efficiency of maternal health care services. METHODS: A community-based, cross-sectional study was carried out in the catchment area of Gutu Mission Hospital, in rural Zimbabwe, from January to June 1996. Two hundred and thirty-five women, aged 16 to 54 years, who had delivered a child in the past three years were interviewed on general characteristics (age, marital status, religion, education, work), obstetric history, use of family planning, pregnancy complications, number of antenatal visits, and use of maternity waiting shelters. Associations of these factors to non-use of antenatal care facilities and hospital delivery were studied. In the Gutu district, guidelines exist to identify women at high risk of complications during pregnancy and to indicate where women should give birth (hospital, rural clinic or at home). We evaluated which factors were important for non-compliance to these guidelines. The analyses were performed using a logistic regression model. RESULTS: Ninety-seven percent of the pregnant women attended the antenatal care facilities at least once. Seventy-three percent came at least five times or more. Belonging to certain religious groups proved to be the strongest explanatory factor for not attending antenatal care facilities. Use of maternity waiting shelters and complications during the pregnancy were important factors for hospital delivery, whereas unemployment and being without a husband were associated with deliveries outside the hospital. Identification as high risk of a complicated pregnancy by application of the existing guidelines was not associated with place of delivery. Delivery at a location that did not conform to the existing guidelines was associated with non-use of maternity waiting shelters, unemployment or being without a husband and use of traditional care. CONCLUSIONS: Our study showed a high attendance rate at antenatal care facilities in the Gutu District. By analyzing determinants of non-use of antenatal care facilities, of hospital delivery and of inappropriate location of delivery according to local guidelines, we identified certain risk factors which are suitable for modification and may help to improve antenatal and perinatal care in the Gutu District in Zimbabwe.     

Economic and social implications of multiple birth

This paper provides the background statistics and trends on multiple births. It highlights a number of factors that influence parents with multiples, including social situation, psychological adjustment and economic circumstances. It is often assumed that these areas of concern arise only after the babies have been born, but clinicians should be aware that many are seen in the antenatal period as well. Apart from the socioeconomic cost to individual families, multiple births also carry a cost to society. A number of self-help groups and voluntary organisations can assist parents of multiples. This is especially important if parents find that family and friends cannot or will not come forward.