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研究生:余靜如
研究生(外文):Ching-Ju Yu
論文名稱:臺灣多胞胎妊娠婦女於接受減胎術之決策歷程
論文名稱(外文):Decision-Making Process of Taiwanese Women with Multifetal Pregnancies Who Receive Fetal Reduction
指導教授:黃璉華黃璉華引用關係
指導教授(外文):Lian-Hua Huang
口試委員:柯滄銘賀姝霞
口試日期:2015-07-23
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:分子醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2015
畢業學年度:103
語文別:中文
論文頁數:98
中文關鍵詞:多胞胎妊娠減胎術決策憂鬱
外文關鍵詞:multifetal pregnanciesfetal reductiondecision-makingdepression
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減胎手術指將多胞胎妊娠的胎兒總數減少的過程。當懷三胎或四胎(高胎數)時,會造成流產、死胎的危險機率上升且對胎兒造成永久性的傷害,多胞胎妊娠會增加母體及胎兒的合併症,醫療上建議減胎。
本研究目的係探討多胞胎婦女面對減胎術決策的過程與產前憂鬱程度。以立意取樣方式在台北市某婦產專科診所,進行多胞胎婦女面對減胎時之決策因素問卷調查,共收取112位個案。研究工具為結構式問卷,內容包括研究對象基本屬性、懷孕經驗、減胎決策量表、愛丁堡周產期憂鬱量表。使用統計方式包括獨立樣本t檢定、單因子變異數分析、皮爾森相關係數。
研究結果發現:
1.研究對象基本屬性與懷孕經驗在決策因素量表分析並無顯著差異,僅是否育有小孩在身體負荷方面考量、多胞胎兒的生命及健康品質、家庭及社會負擔、獲得減胎相關資訊、如何增強內心自我力量在統計上具顯著差異(p< .05)。
2.研究對象基本屬性與懷孕經驗在愛丁堡周產期憂鬱量表分析,發現流產經驗及職業類別具有顯著性(p< .05),有流產經驗總分較無流產經驗者高,職業類別以家庭主婦高於職業婦女。
3.以愛丁堡周產期憂鬱量表14分為憂鬱的分割點,26%的多胞胎孕婦有憂鬱情形。
本研究結果可協助產科護理人員了解多胞胎孕婦在面對減胎時影響其決策因素及孕期憂鬱程度,並作為提供孕婦健康照護之參考。


Multifetal pregnancy reduction (MFPR) is a procedure used to reduce the number of fetuses in a multiple pregnancy. When a pregnancy involves three or more fetuses (high-order pregnancy), the risks of miscarriage, stillbirth, and lifelong disability increase with each additional fetus. A result that the multiple gestation will cause the medical risk of fetus(es) and mother, fetal reductions are recommended. This research aimed to discover the relationship between decision-making process of MFPR and degree of depression in pregnancy. 112 subjects were recruited using structured questionnaires from an obstetric clinic in Taipei. The structured questionnaire includes the demographic background, Pregnancy experience, Reduction of Decision-making Scale, and Edinburgh Perinatal Depression Scale (EPDS). Statistical Analysis includes the t-test, one-way ANOVA test, and Pearson correlation.
The results suggested Decision-making Factor Scale of MFPR was not statistically significant in demographic background and pregnancy experience. However, it was significantly different (p< .05) in the subject whether raising children as body burden, wellness of fetus, household and social issues, collecting fetal reduction information, and how to enhance self-mental strength. The EPDS showed abortion experiences and occupations types statistically significant different (p< .05). The EPDS score of women with previous abortion were higher than no abortion, and unemployment were also higher than career women.
Using the EPDS cutoff score of 14 and above as a score indicative of depression, 26% of subjects were classified as depressed with fetal reduction.
The research results provide evidence information that influence decision-making factor of MFPR and the depression of pregnancy, and facilitate the development of appropriate health care.


口試委員會審定書....................................................i
誌謝...............................................................ii
中文摘要..........................................................iii
英文摘要...........................................................iv
第一章 緒論..........................................................1
第一節 研究動機.................................................1
第二節 研究目的.................................................5
第三節 名詞定義.................................................6
第二章 文獻探討..................................................... 7
第一節 人工生殖技術及妊娠合併症.................................7
第二節 減胎術...............................................,...7
第三節 決策的概念..............................................17
第四節 周產期憂鬱..............................................20
第三章 研究架構及假設...............................................22
第一節 研究架構................................................22
第二節 研究假設................................................23
第四章研究方法......................................................24
第一節 研究設計................................................24
第二節 研究場所................................................24
第三節 研究對象................................................24
第四節 研究工具................................................25
第五節 研究工具的信效度檢定....................................25
第六節 倫理考量................................................29
第七節 資料的收集與分析........................................29
第八節 受試者資料保護措施......................................30
第五章 研究結果.....................................................31
第一節 基本屬性之分析..........................................32
第二節 懷孕經驗之分析..........................................35
第三節 減胎決策因素量表之分析..................................37
第四節 愛丁堡周產期憂鬱量表之分析..............................46
第五節 基本屬性與減胎決策因素之變項分析........................48
第六節 懷孕經驗與減胎決策因素之變項分析........................51
第七節 基本屬性與愛丁堡周產期憂鬱量表之變項分析................63
第八節 懷孕經驗與愛丁堡周產期憂鬱量表之變項分析................65
第九節 減胎留下胎兒數與懷孕經驗之相關性........................67
第六章 討論......................................................... 68
第一節 影響多胞胎妊娠孕婦於接受減胎術之決策探討................68
第二節 多胞胎妊娠孕婦於接受減胎術留下胎兒數與懷孕經驗探討......70
第三節 多胞胎妊娠抉擇減胎術之其他相關因素......................71
第四節 多胞胎妊娠孕婦接受減胎術之憂鬱程度分析..................72
第七章 結論與建議...................................................74
第一節 結論....................................................74
第二節 臨床與研究建議..........................................76
第八章 研究限制.....................................................78
參考文獻............................................................79
中文部分.......................................................79
英文部分.......................................................82
附錄
附錄一 專家效度名單........................................... 88

附錄二 問卷內容............................................... 89
附錄三 倫理委員會審查通用之公文............................... 97


中文部分
小知堂编譯組(1994).問題決策與決策制定.台北:小知堂。

王存國、季延平、范懿文(1996) .決策支援系統.台北.三民。

王怡淨 (2011).孕期憂鬱的生物與心理社會相關因子之分析(碩士論文).取自華藝線上圖書館。

王慧蘭 (2001).多胞胎妊娠婦女於接受減胎術初期之經驗感受及因應行為研究(碩士論文)‧台北:臺灣大學護理學研究所。

中華民國周產期醫學會 (1995).台灣之多胞胎妊娠.台北:中華民國周產期醫
學會。

台灣生殖醫學會 (2012) .台灣生殖醫學會胚胎植入數指引 2012.取自http://www.tsrm.org.tw/news/content.asp?id=15。

吳統雄 (1990)。電話調:理論與方法。臺北:聯經。

邱碧玉 (2004).割捨與維護孕育的經驗歷程-多胞胎孕婦接受減胎手術的生活經驗與因應行為研究(碩士論文).台北:臺灣大學護理學研究所。

柯滄銘 (1994).超音波.胎兒.你.台北:健康世界。

柯滄銘 (2004,1月5日).多胞胎減胎術.取自
http ://www. genephile. com. tw/articles/多胞胎的減胎.htm。

胡美連(2003).照顧一位經人工生殖致多胞胎妊娠之不孕症婦女減胎的護理經驗.護理雜誌,50(2),92-98。

徐禎美(2002) ‧第三孕期婦女的壓力、社會支持與憂鬱(碩士論文) :高雄醫學大學護理學系研究所。

徐禎美、陳彰惠 (2008).孕期憂鬱的盛行率和預測因子.實證護理,4(2),149-156。

連義隆 (1998) ‧多胞胎的形成與減胎術 ‧ 於中華民國不孕症暨生殖內分泌醫學
會编著,不孕症及生殖內分泌學 ‧ 台北:合記。

郭旭松、莊人祥 (1996).山城杏話:醫學生談醫學倫理.台北:合記。

陳淑溫 (1996).接受人工生殖初次懷孕婦女於第一孕期之維護及調適行為(碩士論文).台北:台灣大學護理研究所。

陳淑溫 (2000).接受人工生殖初次懷孕婦女於第一孕期之監測及維護行為‧護理研究,8 ( 3 ),289-299。

張正昌、張盈寬、陳維華、劉杭生 (1998).絨毛取樣術與產前遺傳診斷.國防醫學,26(2),109-115。

國民健康局 (2013).100年台灣地區人工生殖施行結果分析報告.取自http://www.hpa.gov.tw/DOWNLOAD/100年台灣地區人工生殖施行結果分析報告.pdf。

曹國桃 (1990).多胞懷孕在懷孕之前期選擇性中止懷孕之研究.台灣醫界,
33 (7) ,73-74 。

曾雅玲 (1999).多胎妊娠減胎術.護理雜誌,46(4),40-44。

游伯龍 (1999).人生的新境界.台北:聯經 。

楊友仕、陳信孚 (1997).輸卵管內植入術.於宋永魁等編,不孕症生殖內分泌學 (319-321頁).台北:合記。

楊友仕 (1991).人類體外受精及相關生殖技術之研究(博士論文).台北:臺灣大學臨床醫學研究所。

詹德隆 (1997).倫理決定.情緒影響及德行培育的互動.專業論文集(二).北縣:輔仁大學出版社。

戴蕙蓮(2014).自然妊娠與生殖科技妊娠孕婦之憂鬱、社會支持及母胎依附之比較(碩士論文).臺北護理健康大學 護理助產研究所。


英文部分
Angel, J. L., Kal ter, C. S., Morales, W. J., Rasmussen, C. & Caron, L. (1999).
Aggressive perinatal care for high-order multiple gestations: Does good perinatal
outcome justify Aggressive nsqistcd reproductive techniques? American Journal of
Obstetrics Gynecologv, 181, 253-258.

Antsaklis A, Daskalakis G, Papantoniou N et al. (2000). Genetic amniocentesis in multifetal pregnancies reduced to twins compared with nonreduced twin gestations. Fertility and Sterility, 74, 1051-1052.

Ata, Bl., Rasillo, LJ. et al. (2011). Obstetric outcomes of IVF trichorionic triamniotic triplets which are spontaneously or electively reduced to twins. Journal of Assisted Reproduction and Genetics, 28(12), 1217-22.

Brambati, B., Tului, L., Baldi, M. & Guercilena, S. (1995). Genetic analysis prior to selective fetal reduction in multiple pregnancy: technical aspects and clinical outcome. Hum Reproduction, 10(4), 818-825.

Brambati, B., Tului, L., Guercilena, S., Albert, E. (2001) Outcome of first-trimester chorionic villus sampling for genetic investigation in multiple pregnancy. Ultrasound Obstet Gynecol, 17(3), 209-216.

Brambati, B., Tutui, L., Baldi, M., & Guercilena, S. (1995) Genetic analysis prior to selective fetal reduction in multiple pregnancy: technical aspects and clinical outcome. Human Reproduction, 10(4), 818-825.

Bennett HA et al. (2004) Depression during pregnancy. Clinical Drug Investigation , 24, 157.

Cox J, Holden J, Sagovsky R. (1987) Detection of postnatal depression. Development of the 10 item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry, 150, 782-786.

De Catte L, Camus M, Bonduelle M et al. (1998) Prenatal diagnosis by chorionic villus sampling in multiple pregnancies prior to fetal reduction. American Journal of Perinatol, 15, 339-343.

Harton GL et al. (2013) Diminished effect of maternal age on implantation after preimplantation genetic diagnosis with array comparative genomic hybridization. Fertility and Sterility, 100 (6), 1695-703.

Evans MI, Berkowitz RL, Wapner RJ et al. (2001) Improvement in outcomes of multifetal pregnancy reduction with increased experience. American Journal of Obstetrics & Gynecology, 184, 97-103.

Evans MI, Goldberg JD, Horenstein J et al. (1999) Selective termination for structural, chromosomal, and mendelian anomalies: International experience. American Journal of Obstetrics & Gynecology, 181, 893-897.

Evans MI, Kramer RL et al. (1998) What are the ethical and technical problems associated with multifetal pregnancy reduction? Clinical Obstetrics Gynecology, 41(1), 46-54.
Evans MI, Littman L, Richter R et al. (1997) Selective reduction for multiple pregnancy, early opinions revisited. The Journal of Reproductive Medicine, 42, 771-777.

Eddleman, K. A., Stone et al. (2000) Chorionic villus sampling before multifetal pregnancy reduction. American Journal of Obstetrics and Gynecology, 183 (5), 1078-1081.

Elster, N. (2000) Less is more: the risks of multiple births. Fertility & Sterility, 74 (4), 617-623.

Evans, M. I., Kramer, R. L. et al. (1998) What are the ethical and technical problems associ ated with multifetal pregnancy reduction? Clinical Obstetrics & Gynecology, 41 (1), 46-54.

Evans, M. I., Berkowitz, R. L., Wapner, R. J., Carpenter, R. J., Goldberg, J. D., Ayoub, M. A. et al. (2001) Improvement in outcomes of multifetal pregnancy reduction with increased experience. American Journal of Obstetrics & Gynecology, 184 (2), 97-103.

Goldfarb, J., Kinzer, D. J., Boyle, M., & Kurit, D. (1996) Attitudes of in vitro fertilization and intrauterine insemination couples toward multiple gestation pregnancy and multifetal pregnancy reduction. Fertility & Sterility, 65 (4), 815-820.

Heh SS. (2001) Validation of the Chinese version of the Edinburgh Postnatal Depression Scale: detecting postnatal depression in Taiwanese women. The Journal of Nursing Research, 9, 105-113.

Huang, H. et al. (2002) Analysis of 55 cases of transvaginal multifetal pregnancy reduction. Chinese Journal of Obstetrics & Gynecology, 37 (9), 533-535.

Jenkins, T. M., & Wapner R. J. (2001) Genetic evaluation. In Blickstein, I., & Keith, L. G. (Eds.), latrogenic multiple pregnancy : clinical implications (pp. 151-172) New York :Parthenon Pub. Group.

Ko, T-M.et al. (1999) Multifetal pregnancy reduction in 100 pregnancies. Taiwanese Journal of Obstetrics and Gynecology, 38(2), 51-56.

Lee D, Yip S, Chiu H. et al. (1998) Detecting postnatal depression in Chinese women. Validation of the Chinese version of the Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry, 172, 433-437.

Lusskin SI. et al. (2007) Perinatal depression: hiding in plain sight. The Canadian Journal of Psychiatry, 52,479.

Matteson, P & Hawkins, J. W. (1990) Concept analysis of decision making. Nursing Forum, 25 (2), 4-10.

Mckinney, M., Downey, J. & Timor-Tritsch, I. (1995) The psychological effects or multifetal pregnancy reduction. Fertility and Sterility, 164 (1), 51-61.

Maifeld, M., Hahn, S., Titler, M. G., & Mullen, M. (2003) Decision making regarding multifetal reduction. Journal of Obstetric,Gynecologic, & Neonatal Nursing, 32 (3), 357-369.

Ormont, M. A. Shapiro, P. A. (1995) Multifetal pregnancy reducion. Psychosomatics, 36(52), 522-529.

Redelmeier, D A. Rozin, P. & Kahenanan, Daniel. (1993) Understanding patient''s
decisions-congnitive and emotional perspectives. Journal of American Medicine, 270 (1 ), 72-76.

Robin, M.H. (1987) Judgement and Choice-The Psychology of Decision. Chichester :
John Wiley & Sons.

Schreiner-Engel. et al. (1995) Frist-trimester multifetal pregnancy reduction : Acute and persistent psycholgical reactions. American Journal of Obstetrics Gynecology, 172 (2), 514-546.

Smith-Levitin, M. & Petrikovsky, B. (1997) Ethics of multifetal pregnancy reduction:
A Secular and religious perspective. Neonatal Intensive Care, 10 (2), 36-37.

Ko,T-M. ,Yang, Y-S. et al. (1991) Selective reduction of multiple pregnancies in the first trimester or early second trimester. Journal of Formosan Medical Association, 90 (5), 493-497.

Vauthier-Brouzes, D. Lefebvre, G. (1992) Selective reduction in multifetal preganancies : technical and psychological aspects. Fertility Sterility, 57, 1012-1016.

Wapner, R. J. et al. (1993) Prenatal diagnosis in twin gestations : a comparison between
second-trimester amniocentesis and first-trimester chorionic villus sampling. Obstetrics & Gynecology, 82 (1), 49-56.

Werner M, Reh A, Grifo JA, Perle MA. (2012) Characteristics of chromosomal
abnormalities diagnosed after spontaneous abortions in an infertile population.
Journal of Assisted Reproduction and Genetics, 29, 817-20.

Zhang J, Li HY, Wang XT, Hou HY. (2011) Comparative study of pregnancy outcomes between spontaneous twin pregnancies and twin pregnancies after fetal reduction in the second trimester. Zhonghua Fu Chan Ke Za Zhi, 46(12), 901-4.


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