| Objectives(1)The purpose of this study was to explore the real experiences of pregnant women underwent termination of pregnancy due to a fetal anomaly during the postpartum period,in order to provide reference and develop targeted interventions for improving women’s mental state.(2)To develop an intervention program for women underwent termination of pregnancy due to a fetal anomaly during the postpartum period and confirm the effectiveness of the intervention,and ultimately help the women reduce anxiety and depression symptom,enhance the post-traumatic growth.MethodsThis subject adopts mixed research design.Firstly,a qualitative study was employed to understand the real experiences of pregnant women underwent termination of pregnancy due to a fetal anomaly during the postpartum period.Secondly an intervention program was constructed based on the qualitative research results,and apreliminary clinical trial was conducted to verify the effectiveness of the intervention.(1)Qualitative study of experiences during the postpartum periodUsing phenomenological method,combined with the Generalized Anxiety Disorder(GAD-7)Scale and the Patient Health Questionnaire(PHQ-9),13 abnormal fetal induced labor women who visited the postpartum clinic of a maternity hospital in Hangzhou from June to September 2018 were selected as subjects.After 42 days of induced labor,participants were interviewed and assessed with the GAD-7 and PHQ-9.The interview content was analyzed by Colaizzi’s 7-step method.(2)The construction and evaluation of the interventionFirst,the puerperal psychological intervention program was developed based on the stress process model,findings from previous qualitative study,literature and expert group meetings.Then the feasibility and potential effects of this program were explored in an experimental study with quantitative data.A convenience sample of 84 participants were recruited from a maternity hospital Hangzhou,from December 2018 to August 2019.The eligible participants were randomly assigned to the intervention group(n=40)and the control group(n=41).The participants in the intervention group received the puerperal psychological intervention program plus the routine care.The subjects in the control group received the routine care.The effects were evaluated before and 24 hours after intervention by proper measures including,the GAD-7,the Edinburgh Postnatal Depression Scale(EPDS)and Chinese-Posttraumatic Growth Inventory(C-PTGI).Results(1)The results of the qualitative studyFour themes emerged as the psychological experience of women with abnormal induced abortion during postpartum period:(1)Coexisting of negative and positiveexperiences;(2)Multiple factors aggravating negative experiences during postpartum period;(3)Obviously insufficient social support is for women during postpartum period;(4)Puerperal supportive care needs involve information,physical,emotional and social support and daily life.The results of GAD-7 and PHQ-9 showed that among the 13 participants,7(53.8%)had anxiety and depression,of which 5(38.5%)with mild anxiety and depression,1(7.7%)with moderate anxiety and depression,and 1(7.7%)with severe anxiety and extremely severe depression.(2)The implementation and evaluation for the interventionAs a result of the experimental study,33 participants in the intervention group and38 participants in the control group finished the intervention.There were no significant differences between the two group before the puerperal psychological intervention program.Regarding GAD-7,there was a significant difference(P<0.005)between the intervention group and the control group at the post-test.The intervention group showed a significant decrease in anxiety symptoms(P<0.005)after the program,and significance difference(P<0.05)was also found in the control group.As for EPDS there was a significant difference(P<0.005)between the intervention group and the control group at the post-test.The intervention group showed a significant decrease in depression symptoms(P<0.005)after the program,and significance difference(P<0.05)was also found in the control group.For the C-PTGI total score,appreciation of life dimension,new possibilities dimension,there was a significant difference(P<0.005)between the intervention group and the control group at the post-test.The intervention group showed a significant decrease in the level of PTG,new possibilities dimension(P<0.005)after the program and no significance difference(P>0.05)was found in the control group.Conclusion(1)Psychological experience of women underwent termination of pregnancy due tofetal anomaly during the postpartum period is not optimistic,which should attract attention of hospitals,communities,and families.(2)An intervention program during the postpartum period for women with termination of pregnancy for a fetal anomaly during the postpartum period can help women alleviate maternal anxiety and depression,improve post-traumatic growth level.The intervention has been proved to be a certain clinical value. |
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