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Reasons for Second Trimester Abortions and the Role of Psychological Intervention Alleviating the Negative Emotions in Patients

Author: ZhangZuoLin
Tutor: HuangXiangHua
School: Hebei Medical University
Course: Obstetrics and Gynaecology
Keywords: Second trimester pregnancy Abortion Three levels ofprevention Influencing factors Anxiety Depression Psychologicalintervention
CLC: R719.3
Type: Master's thesis
Year: 2013
Downloads: 9
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Abstract

How to effectively prevent the second trimester abortion with highincidence and risk is not just a medical problem. It is related with health andsociety factors, such as religion, law, ethics, economic, culture, social securityand health services. Under the guidance of the model of the Biological–Psychology-Medicine, the prevention of the second trimester abortion shouldcombine with clinical medicine and social medicine by three levels ofprevention.Objective: To analyze the population characteristics, influence factors,delay causes and negative emotion of those patients who aborting in thesecond trimester, in order to pertinent prevention measures and provide thescientific intervention by analyzing the data about social and medical factorsof second trimester abortion.Materials and Methods:1Data collection for primary prevention studyTo collect personal information, marital status, pregnancy terminationreasons and contraceptive measures of those through the second trimesterabortion from the Second Hospital of Hebei Medical University during theperiod of January2008to December2012.2Data collection for secondary prevention studyTo choose in patients who required termination pregnancy (＜24weeks)of their own accord from the Second Hospital of Hebei Medical Universityduring the period of January2012to December2012. And those had beendivided into two groups, i.e. the control group (the second trimester abortiongroup) and study group (the first trimester abortion group). To collect personalinformation, marital status and pregnancy termination reason by interviewing face to face.3Data collection for tertiary prevention studyTo choose inpatients who required the second termination pregnancy oftheir own accord from the Second Hospital of Hebei Medical Universityduring the period of January2012to December2012. And those had beendivided into two groups, i.e. the control (conventional treatment) and studygroup (psychological intervention). This study was assessed negative emotionsby self-rating anxiety scale (SAS) and self-rating depression scale (SDS) afteradmission and before discharge, assessed verbal rating scale-5(VRS-5) bydescribing the pain scores after admission.4Statistical analysesStatistical analysis was performed by using SPSS19.0statistical software,measurement data use ((x|-)±s) said; the comparison of quantitative data by t-test,the comparison of qualitative material by Pearson chi-square test. Thestatistical significance in this study was α=0.05.Result:1Primary prevention studiesThe average age of573patients through the second trimester abortionwas26.53, of which the number of people aged between21and25was thelargest. Farmer (41.54%), unemployed (15.53%) and student (14.14%). Theproportion of people with junior high school education is64.05%. Countrydweller is38.22%. Unmarried is37.87%.45.03%of which was their firstpregnancy,55.85%had not delivered. Married but unintended pregnancy(45.03%), unmarried pregnancy (37.87%), economic problem (20.24%),study/work reasons (17.63%), illnesses in pregnant women should notcontinue pregnancy (14.49%), fetal abnormalities (12.91%) and familyconflict (7.16%) were the main reasons of pregnancy termination.2Secondary prevention studiesThe reasons of the termination of extension to more than13weeks ofpregnancy were pregnancy unconfirmed timely, making decision not in timelymanner after pregnancy confirmed, the accident and abnormal development of fetus.The comparison of age between first and second trimester abortion group,χ~2=69.95，P＜0.001，showed statistically significant difference.The comparison of occupation between first and second trimesterabortion group, χ~2=159.11，P＜0.001，showed statistically significantdifference.The comparison of income stable or not between first and secondtrimester abortion group, χ~2=9.474，P=0.002，showed statistically significantdifference.The comparison of education between first and second trimester abortiongroup, χ~2=80.61，P＜0.001, showed statistically significant difference.The comparison of residence between first and second trimester abortiongroup, χ~2=54.50，P＜0.001，showed statistically significant difference.The comparison of pregnancy history between first and second trimesterabortion group, χ~2=27.714， P＜0.001, showed statistically significantdifference.The comparison of childbearing history between first and secondtrimester abortion group, χ~2=23.95, P＜0.001, showed statisticallysignificant difference.The comparison of abortion history between first and second trimesterabortion group, χ~2=29.847, P＜0.001, showed statistically significantdifference.3Tertiary prevention studiesThe average score of SAS after admission: study group41.89, controlgroup45.79, showed statistically significant difference (t=-2.22, P=0.028).The average score of SAS before discharge: study group40.47, controlgroup47.64, showed statistically significant difference (t=-4.14, P<0.000).The average score of SDS after admission: study group46.35, controlgroup48.00, showed no statistically significant difference (t=-1.51, P=0.133).The average score of SDS before discharge: study group47.96, controlgroup50.43, showed statistically significant difference (t=-2.07, P=0.040). The average score of VRS-5: study group3.13, control group3.52,showed statistically significant difference (t=-2.80, P=0.006).Conclusion:The primary prevention for the second trimester abortion should beaimed at young, farmers, low level of education, rural residents, no pregnancywomen, and we should publicize scientific contraceptive measures. Thesecondary prevention should focus on the guidance for females, includingattention to pregnancy signs, self-awareness improvement, getting the familysupport, avoid accident during pregnancy. The tertiary prevention needs us totreat inpatients actively and take psychological intervention in order to reducethe negative influence of negative emotions on the physical and mental health.

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