untitled

Size: px

Start display at page:

Download "untitled"

五卷农
9 years ago
Views:

2 Abstract In this third year study, there are two parts: in the first part, we want to explore the effect of genetic counseling on helping pregnant women with abnormal fetus(es) (including chromosomal anomalies) to understand the informed consent and on alleviating anxiety of them. The subjects were 50 pregnant women who opted artificial abortion in delivery room in a medical center. Genetic counseling was provided to 28 women (experimental group) before answering the questionnaire whereas to 22 women control group after answering the questionnaire. More subjects in experimental group thought the inform consent providing complete information. The anxiety of experimental group is lower than the control group, but it is not statistically different in the statistics. In the second part, we interviewed 400 postpartum women to inquiry their experience of taking the maternal serum screening, ultrasound, amniocentesis. We also used Knowledge of Prenatal Screening and Diagnostic Tests and Women s Attitudes Towards the Pregnancy and the Fetus to understand the willingness of participating the prenatal screening and willingness-to-pay for the examination. In conclusion, genetic counseling can help the pregnant women to have more information for the abnormal prenatal diagnosis. Most of the postpartum women were satisfied to the informed consent given at outpatient clinic and would like to undergo prenatal serum screening as well as sonographic examination in their next pregnancy. Key words: prenatal diagnosis, antenatal maternal serum screening, ultrasound, artificial abortion, ethics I

3 II

4 III

5 Maternal Serum Screening Ultrasound amniocentesis 5-10% maternal-fetal attachment /

6 Ko et al., Kuller & laifer, 1996 Skidmore et al., /1000 Lin, S.J. et al, % Parker et al., 2003 Christian et al., 2000 Marteau et al., Lin et al., Rubin

7 State Trait Anxiety Inventory, STAI Spielberger 1970 Consulting Psychologists Press

8 Reading AE, Cox DN, Sledmere CM, Campbell S 1984 Health Psychology: the Official Journal of the Division of Health Psychology, American Psychological Association SPSS/PC % 34% 32% 4%~6% % 36% % % % 70% 1 N=50 n=22 (%) (n=28) (%) X

9 N=50 n=22 (%) (n=28) (%) X

10 , ,000-49, ,000-74, ,000-99, , , , % % % %25 (89.3%) % % % % % % % 1 3.6% % % % % % 2 7.1% 1 3.6% 63.6% 85.7% X 2 =3.92 p % 27.3% 18.2% 100.0% 50.0% 25.0% 6

11 2 (N=50) n=22 (%) (n=28) (%) X

12 p< % % % 2 9.1% % % % % % % % % 72.7% 89.3% 18.2% 57.1% X 2 =7.79 p< (N=50) n=22 (%) (n=28) (%) X

13 < < (N=50)- n=22 (%) (n=28) (%) X

14 p<0.05 State Trait Anxiety Inventory STAI t t 10

15 4 (N=50) n=22 n=28 t (N=50) n=22 n=28 t

16 , SAS/PC % % / % % 35% % % 50, , % 100, , % % % 6-1 n % /

17 , ,001-50, , , , , , , , n Mean SD n %

18 / % 98.7% 39.8% 7~ % 4 1% < % 89.1% % 96% P=0.038<0.005/ 94.7% 100% P< % 98.6% % % P=0.047 P=0.039 P< % % % / 5 6.8% 37 12% 13.5% 8.4% % % 14

19 7 n % <35 35 P-value n % n % b a a a a a a 1 a Chi-Square test b Fisher's Exact Test 15

20 7-2 / P-value n % n % b a a a <0.001 a a a 1 a Chi-Square test b Fisher's Exact Test 7-3 P-value n % n % b a a a a a 16

21 a 1 Chi-Square test Fisher's Exact Test P-value n % n % b a a a a a a 1 a Chi-Square test b Fisher's Exact Test 77.4%57.5% % 75.3% 61.5% 53.8% % 44.8% 33.3% 8 8 n %

22 % 84.9% 21.7% % 6 1.5% % % % 23.4% % 1.7% % 16% 32 34% 1.1% / % % / 18

23 83.8% 17.6% % 1.3% 84.6% 22.5% 61 20% 1.6% % % 86.5% 19.5% % 1.6% 82.4% 23.5% % 1.5% % % % 20.5% % 2.3% % 20.2% % 0 p=0.002<0.05 p=0.021<0.05 1: % 1: % 5-10% % 1-2% % 35 1: % 1: % 5-10% % 1-2% % 35 1: % 1: % 5-10% 19

24 % 1-2% % / 1: % 1: % 5-10% % 1-2% % 1: % 1: % 5-10% % 1-2% % 1: % 1: % 5-10% % 1-2% 49 28% 1: % 1: % 5-10% % 1-2% 59 33% 10 1: % 1: % 5-10% % 1-2% % 10 1: % 1: % 5-10% 18 17% 1-2% 41 39% 1:270 1: % 20

25 p=0.017< n % (>1:270) (>1:270) (<1:270) (<1:270) % ( ) % ( ) ( ) 1-2% <35 35 n % n % P-value b

26 a a a b a b a (>1:270) a (>1:270) a 1 (<1:270) b (<1:270) a % ( ) a 50% ( ) a ( ) 1-2% a 1 a Chi-Square test b Fisher's Exact Test 9-2 / P-value n % n % b a 22

27 a a b a b a (>1:270) a (>1:270) a 1 (<1:270) b (<1:270) <0.001 a 5-10% ( ) a 50% ( ) a ( ) 1-2% a 1 a Chi-Square test b Fisher's Exact Test 9-3 P-value n % n % b a a 23

28 a a a a a (>1:270) a (>1:270) a 1 (<1:270) b (<1:270) a % ( ) a 50% ( ) a ( ) 1-2% a 1 a Chi-Square test b Fisher's Exact Test P-value n % n % b a a a 24

29 b a b a (>1:270) a (>1:270) a 1 (<1:270) b (<1:270) a % ( ) a 50% ( ) a ( ) 1-2% a 1 a Chi-Square test b Fisher's Exact Test % % 9 3.1% % % % n %

30 % % % % 1 0.3% 6 2% 55.4% 42.9% 1.7% % % % 3 1% n %

31 [ ] 77.3% 16.7% 2.9% 3.1% % % 8 2.1% % % 1, % 1,001-2, % 2,001-3, % 3,001-4, % 4,001-5, % 5, % 12 27

32 12 n % ( ) n %

33 % 94.5% 80.4% 81.2% % 85.1% 93.4% 1 0.3% % % p=0.01< / 76.3% 63.6% p=0.036 / 34.2% 51.7% p=0.006< % % p=0.045< % 54.2% 44.8% 1% 94.2% 5.8% n %

34 <35 35 P-value n % n % a a a a a b a Chi-Square test Fisher's Exact Test 13-2 / P-value n % n % a a a 30

35 a a b a a a a 1 Chi-Square test Fisher's Exact Test 13-3 P-value n % n % a a a a a b a a a a 1 Chi-Square test Fisher's Exact Test 31

36 P-value n % n % a a a a a b a a a a 1 Chi-Square test Fisher's Exact Test 14 n %

37 91.2% 83.5% 78.2% % % % n %

38 [ ] 87.5% 12.3% 0.3% 61.6% 1, % 1,001-2, % 10, n % % 1% 34

39 % % % 0.8% 98.1% 74.7% 31.2% % 86.6% 33.8% % 35 98% p<0.001 / 5.3% / 46.9% 62.1% p=0.047< % % p=0.017< % % p=0.007< ~ n %

40 <35 35 n % n % P-value b b a a b b a <0.001 a 36

41 b a b b a a a a a b b 1 a Chi-Square test b Fisher's Exact Test 17-2 / n % n % P-value b b b a b b a 37

42 a b a b b a a a b a b b 1 a Chi-Square test b Fisher's Exact Test 17-3 n % n % P-value b b a a b b

43 a a a a b b a a a a a b b 1 a Chi-Square test b Fisher's Exact Test n % n % P-value b b a a b b 39

44 a a b a b b a a a a a b b 1 a Chi-Square test b Fisher's Exact Test % 68.8% 16.9% 4.6% 6.5% 18.3% n %

45 ( ) % % % 96.8% 1.3% 2.6% n %

46 [ ] 59.3% 29.8% 9.6% 1.4% 8,000 1% 18, n %

47 ~ n Mean SD Range ~ ~ ~ ~ 44 43

48 21-1 <35 35 P-value c n Mean SD n Mean SD c Student s t test 21-2 / P-value n Mean SD n Mean SD c Student s t test 21-3 P-value n Mean SD n Mean SD c Student s t test 44

49 P-value n Mean SD n Mean SD c Student s t test 70% Evans et al.,

50 1998 3(2) (2) (2) (2) Cederbolm, M., Axelsson, O., & Sjoden, P. O. (1999). Women s knowledge, concerns and psychological reactions before undergoing an invasive procedure for prenatal karyotyping. Ultrasound in Obstetrics and Gynecology, 14, Christian, S. M., Koehn, D., Pillay, R., MacDougall, A., & Wilson, R. D. (2000). Parental decisions following prenatal diagnosis of sex chromosome aneuploidy: a trend over time. Prenatal diagnosis, 20, De Graaf, I. M., Tijmstra, T., Bleker, O. P., & Van Lith, J. M. M. (2002). Womens preference in Down syndrome screening. Prenatal diagnosis, 22, Huang, L. H. (1994). Prenatal screening for high risk pregnancies. Journal of Genetics & Molecular Biology, 5(3), Jallinoja, P., Santalahti, P., Toiviainen, H., & Hemminki, E. (1999). Acceptance of screening and abortion for Down syndrome among finnish midwives and public health nurses. Prenatal Diagnosis, 19, Kaiser, A. S., Ferris, L.E., Pastuszak, A.L., Thomas, H.L., Johnson, J., Conacher, S., & Shaw, B.F. (2002). The effects of prenatal group genetic counseling on knowledge, anxiety and decisional conflict: Issues for Nuchal Translucency Screening. Journal of Obstetrics and Gynaecology, 22(3), Larsen, T., Nguyen, T. H., Munk, M., Svendsen, L., & Teisner, L. (2000). Ultrasound screening in the 2 nd trimester. The pregnant woman s background knowledge, expectations, experiences and acceptances. Ultrasound in Obstetrics and Gynecology, 15,

51 Lin, S. J., Huang, M.C., Chen, S.H., Tsai, C.J., & Shu, S.F. (1995). A follow-up study of genetic counseling in Down syndrome. Acta Paediatrica Taiwanica, 36(3), Marteau, T.M., Johnston, M., Plenicar, M., Shaw, R.W., & Slack, J. (1988). Development of a self-administered questionnaire to measure women s knowledge of prenatal screening and diagnostic tests. Journal of Psychosomatic Research, 32(4), Marteau, T. M., Dormandy, E., & Michie, S. (2001). A measure of informed choice. Health Expectations, 4, Marteau, T. M., Nippert, I., Hall, S., Limbert, C., Reid, M., et al. (2002). Outcomes of pregnancies diagnosed with Klinefelter syndrome: the possible influence of health professionals. Prenatal Diagnosis, 22, Michie, S., Dormandy, E., & Marteau, T.M. (2003). Informed choice: understanding knowledge in the context of screening uptake. Patient Education and Counseling, 50, Parker, M. J., Budd, J. L. S., Draper, E. S., & Young, I.D. (2003). Trisomy 13 and trisomy 18 in a defined population: epidemiological, genetic and prenatal observations. Prenatal Diagnosis, 23, Reading, A.E., Cox, D.N., Sledmere, C.M., & Campbell, S. (1984). Psychological changes over the course of pregnancy: A study of attitudes toward the fetus/neonate. Health Psychology, 3(3), Skidmore, D. L., Pai, A. P., Toi, A., Steele, L., & Chitayat, D. (2003). Prenatal diagnosis of Apert syndrome: report of two cases. Prenatal Diagnosis, 23,

2014年1月A 1期排版.FIT)

2014年1月A 1期排版.FIT) 第 26 卷第 15 期中国现代医学杂志 Vol. 26 No.15 2016 年 8 月 China Journal of Modern Medicine Aug. 2016 DOI: 10.3969/j.issn.1005-8982.2016.15.022 文章编号 : 1005-8982(2016)15-0114-05 声检查对产前出血病因诊断的