بررسی ارتباط ترس از زایمان، اضطراب پنهان و کیفیت خواب در بارداری با پیامد زایمانی در زنان نخست زا

نوع مقاله : اصیل پژوهشی

نویسندگان

1 کارشناس ارشد مامایی، گروه مامایی و بهداشت باروری، دانشکده علوم پزشکی، دانشگاه تربیت مدرس تهران، تهران، ایران.

2 استادیار گروه مامایی و بهداشت باروری، دانشکده پزشکی، دانشگاه تربیت مدرس تهران، تهران، ایران

3 دانشیار گروه آمار زیستی، دانشکده پزشکی، دانشگاه تربیت مدرس تهران، تهران، ایران.

چکیده

مقدمه: اضطراب و ترس از زایمان ممکن است در سه ماهه آخر بارداری با عوارض مامایی، تجربه منفی زایمانی و
افزایش سزارین همراه باشد. مطالعه حاضر با هدف بررسی ارتباط اضطراب، ترس از زایمان و کیفیت خواب در سه
ماهه آخر بارداری با طول لیبر، القاء لیبر و روش زایمان انجام شد.
روشکار: در این مطالعه طولی آینده نگر، 156 زن باردار نخست زا با بارداری تک قلوی طبیعی )سن بارداری28-33
هفته( مراجعه کننده به مراکز بهداشتی– درمانی قم در سال 1383 به طور تصادفی وارد مطالعه شدند. متغیرهای
پیش بین شامل: اضطراب، ترس از زایمان و کیفیت خواب به ترتیب با سه پرسشنامه استاندارد: سنجش اضطراب
پنهان اسپیل برگر )STAI-T(، پرسشنامه نگرش زایمان )CAQ( و پرسشنامه کیفیت خواب پیتزبورگ )PSQI(
سنجیده شدند. متغیرهای پیامد زایمانی شامل: القاء لیبر، لیبر طول کشیده و روش زایمان از طریق پرونده های
پزشکی افراد ثبت شد. داده ها از طریق آزمون های کای دو، تحلیل رگرسیون لجستیک و آزمون همبستگی پیرسون
و با استفاده از نرم افزار آماری SPSS )نسخه 16( تحلیل شدند. میزان p کمتر از 3/35 معنی دار در نظر گرفته شد.
یافتهها: بین اضطراب پنهان، لیبر القاء شده و سزارین انتخابی ارتباط معنی داری وجود داشت )p=3/30(،
)p=3/331(. همچنین در گروه مادران مضطرب، احتمال القاء لیبر و سزارین انتخابی به ترتیب 2 و 13 برابر بیشتر بود
 سزارین و لیبر القاء ،کشیده طول لیبر با اضطراب بین اما .)CI=1/2-85 OR=13/3( )CI=1/1-0/5 OR=2/1(
اورژانسی ارتباط معنی داری مشاهده نشد )p<3/1(. بین نمرات ترس از زایمان و کیفیت خواب با لیبر القاء شده و
طول کشیده، زایمان سزارین ارتباط معنی داری مشاهده نشد )p<3/1(.
نتیجهگیری: بین اضطراب پنهان و لیبر القاء شده و سزارین انتخابی ارتباط معنی داری وجود دارد.

کلیدواژه‌ها


عنوان مقاله [English]

Fear of Childbirth, Trait Anxiety and Quality Sleep in Pregnancy and Birth Outcomes in Nulliparous Woman

نویسندگان [English]

  • Zahra Alipour 1
  • Minoo Lamyian 2
  • Ebrahim Hajizadeh 3
1 M.Sc. of Midwifery, Department of Midwifery and Health Reproductive, Faculty of Medicine, Tarbiat Modares University, Tehran, Iran.
3 Associate Professor, Department of Biostatistics, Faculty of Medicine, Tarbiat Modares University, Tehran, Iran.
چکیده [English]

Introduction: Anxiety and fear of childbirth in the last trimester of pregnancy, possibly is associated with complications of obstetrics, negative experiences and increased cesarean delivery. This study was aimed to study about relationship between anxiety, fear of childbirth and quality of sleep in the third trimester of pregnancy and length of labor, induction of labor and method of delivery.
Methods: In this prospective longitudinal study, 156 pregnant women (23-30 weeks) 2010 who referred to ten health centers in the Qom-­­Iran were included with simple random method. The predictor variables were the anxiety, fear of childbirth and quality sleep scores measured using the spielbrger's trait anxiety inventory, childbirth attitudes questionnaire and Pittsburgh Sleep Quality Index­. The outcome variables were four obstetric complications: induced labor; prolonged labor; emergency cesarean section and method of delivery. Data were analyzed through­­ chi-square test; logistic regression and Pearson correlation ­using SPSS softwareversion 16 was performed. P value less than 0.05 was considered statistically significant.
Results: Relation between trait anxiety in late pregnancy with induced labor and elective caesarean section significant (p=­0.04), (p=­0.001). Women who anxious had an increased risk for elective cesarean section and induced labor (OR=10.3; CI=­1.2–85), (OR=2.1; CI=­1.1–4.5), but not for; ­prolonged labor; emergency cesarean section (p>0.1). Between scores of fear of childbirth and sleep quality with induced labor, ­prolonged labor, emergency and elective caesarean section had not significant relationship (p>0.1).
Conclusions: Trait anxiety had significant relation with elective cesarean section and induced labor and high prevalence of caesarean.

کلیدواژه‌ها [English]

  • Anxiety
  • Cesarean section
  • Fear of childbirth
  • Induced and ­prolonged labor
  • Sleep Quality
1. Poikkeus P, Saisto T, Unkila-Kallio L, Punamaki RL, Repokari L, Vilska S, et al. Fear of childbirth and pregnancyrelated
anxiety in women conceiving with assisted reproduction. Obstet Gynecol 2006 Jul;108(1):70-6.\
2. Spice K, Jones SL, Hadjistavropoulos HD, Kowalyk K, Stewart SH. Prenatal fear of childbirth and anxiety
sensitivity. J Psychosom Obstet Gynaecol2009 Sep;30(3):168-74.
3. Rouhe H, Salmela-Aro K, Halmesmaki E, Saisto T. Fear of childbirth according to parity, gestational age, and
obstetric history. BJOG 2009 Jan;116(1):67-73.
4. Johnson R, Slade P. Does fear of childbirth during pregnancy predict emergency caesarean section? BJOG 2002
Nov;109(11):1213-21.
5. Ryding EL, Wijma B, Wijma K, Rydhstrom H. Fear of childbirth during pregnancy may increase the risk of
emergency cesarean section. Acta Obstet Gynecol Scand 1998 May;77(5):542-7.
6. Bastani F, Hidarnia A, Kazemnejad A, Vafaei M, Kashanian M. A randomized controlled trial of the effects of
applied relaxation training on reducing anxiety and perceived stress in pregnant women. J Midwifery Womens
Health 2005 Jul-Aug;50(4):e36-40.
7. Khorsandi M. [Effect of precede proceed model combined with the health belief model and the self-efficacy to
increase normal childbirth in nulliparous women] [Thsise in Persian]. Tehran:Tarbiat Modarres University;2008.
8. Ponirakis A, Susman EJ, Stifter CA. Negative emotionality and cortisol during adolescent pregnancy and its
effects on infant health and autonomic nervous system reactivity. Dev Psychobiol 1998 Sep;33(2):163-74.
9. 9.Field T, Diego M, Hernandez-Reif M, Figueiredo B, Schanberg S, Kuhn C. Sleep disturbances in depressed
pregnant women and their newborns. Infant Behav Dev 2007 Feb;30(1):127-33.
10. Laursen M Johansen C, Hedegaard M. Fear of childbirth and risk for birth complications in nulliparous women
in the Danish National Birth Cohort. BJOG 2009 Sep;116(10):1350-5.
11. Johnson RC, Slade P. Obstetric complications and anxiety during pregnancy: is there a relationship? J
Psychosom Obstet Gynaecol 2003 Mar;24(1):1-14.
12. Littleton HL, Breitkopf CR, Berenson AB. Correlates of anxiety symptoms during pregnancy and association
with perinatal outcomes: a meta-analysis. Am J Obstet Gynecol 2007 May;196(5):424-32.
13. Bastani F, Hidarnia A, Vafaei M. [Effect of relaxation training based on the synthesizing of the precede model
with the health belief model and the self-efficacy theory on anxiety and pregnancy outcomes among pregnant
women] [Thsise in Persian]. Tehran:Tarbiat Modares University;2005.
14. Grant KA, McMahon C, Austin MP. Maternal anxiety during the transition to parenthood: a prospective study. J
Affect Disord 2008 May;108(1-2):101-11.
15. Nasiri Amiri F, Salmalian H, Hajia-Hamedi M. [Association between prenatal anxiety and spontaneous preterm
birth] [Article in Persian]. J Babol Univ Med Sci 2009;11:42-8. 
 
16. Dayan J, Creveuil C, Herlicoviez M, Herbel C, Baranger E, Savoye C, Thouin A. Role of Anxiety and
Depression in the Onset of Spontaneous Preterm Labor. Am J Epidemiol 2002 Feb 15;155(4):293-301.
17. Lowe NK. Self-efficacy for labor and childbirth fears in nulliparous pregnant women. J Psychosomatic Obstet
Gynecol 2000 Dec;21(4):219-24.
18. Skouteris H, Wertheim EH, Germano C, Paxton SJ, Milgrom J. Assessing sleep during pregnancy: a study
across two time points examining the Pittsburgh Sleep Quality Index and associations with depressive
symptoms. Womens Health Issues 2009 Jan-Feb;19(1):45-51.
19. Ghoreishi A, Aghajani AH. [Sleep quality in Zanjan university medical students]. [Article in Persian]. J Tehran
Univ Med Sci 2008;1:61-7.
20. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap III L, Wenstrom KD. Williams obstetrics. 22nd ed.
New York:McGraw-Hill;2005.
21. Shahhosseini Z, Abedian K, Azimi H. [Role of anxiety during pregnancy in preterm elivery] ]. [Article in
Persian]. J Zanjan Univ Med Sci 2008;16:85-92.
22. Austin MP, Tully L, Parker G. Examining the relationship between antenatal anxiety and postnatal depression. J
Affect Disord. 2007 Aug;101(1-3):169-74.
23. Sutter-Dallay AL, Giaconne-Marcesche V, Glatigny-Dallay E, Verdoux H. Women with anxiety disorders
during pregnancy are at increased risk of intense postpartum depression symptoms: a prospective survey of the
MATQUID cohort. Eur Psychiatry 2004 Dec;19(8):459-63.
24. Leigh B, Milgrom J. Risk factors for antenatal depression, postnatal depression and parenting stress. BMC
Psychiatry 2008 Apr 16;8:24.
25. Klainin P, Arthur DG. Postpartum depression in Asian cultures: a literature review. Int J Nurs Stud 2009
Oct;46(10):1355-73.
26. Andersson L, Sundström-Poromaa I, Wulff M, Aström M, Bixo M. Implications of antenatal depression and
anxiety for obstetric outcome. Obstet Gynecol 2004 Sep;104(3):467-76.
27. 27.Kitzinger S. Recovering Birth. New York:Pocket Books;2000:135.
28. Beebe KR, Lee KA, Carrieri-Kohlman V, Humphreys J. The effects of childbirth self-efficacy and anxiety
during pregnancy on prehospitalization labor. J Obstet Gynecol Neonatal Nurs 2007 Sep-Oct;36(5):410-8.
29. Shayqyan Z, Tabatabaei S K, Sedighi Loye A. [Effect of maternal anxiety in the third trimester of pregnancy and
delivery process and baby mental health] [Article in Persian]. J Nurs Midwifery, Tehran Univ Medi Sci
2008:3(4):57-64.
30. Heimstad R, Dahloe R, Laache I, Skogvoll E, Schei B. Fear of childbirth and history of abuse: implications for
pregnancy and delivery. Acta Obstet Gynecol Scand 2006;85(4):435-40.
31. Waldenström U, Hildingsson I, Ryding EL. Antenatal fear of childbirth and its association with subsequent
caesarean section and experience of childbirth. BJOG 2006 Jun;113(6):638-46.
32. Negahban T, Ansari A. [Does fear of childbirth during pregnancy predict emergency caesarean section in
nulliparous woman?] [Article in Persian]. J Nurs & Midw, Tehran Univ Medi Scie 2008:14(4):73-81.
33. Evans M, Dick M, Clark A. Sleep during the week befor labor relation ships to labor outcomes. Clin Nurs
1995;4(3):234-52.
34. Akbari AA, Bouluri B, Sadegh Niat Kh, Alavi Majd H. [Relationship between sleep disorders in the last month
of pregnancy, labor duration and type of delivery in pregnant women referred to health centers Saghez city in
2006] [Article in Persian]. J Ilam Univ Medi Scie 2006:15(3):8-14.
35. Lee KA, Gay C. Sleep in late pregnancy predicts length of labor and type of delivery. Am J Obstet Gynecol
2004 Dec;191(6):2041-6.
36. Lee KA, Mcenany G, Zaffke ME. REM sleep and mood state in child bearing women: sleepy or weepy? Sleep
2001 Nov 1;23(7):877-85.
37. Saisto T, Salmela-Aro K, Nurmi JE, Halmesmaki E. Psychosocial characteristics of women and their partners
fearing vaginal childbirth. BJOG 2001 May;108(5):492-8.
38. Zar M, Wijma K. Pre-and postpartum fear of childbirth in nulliparous and parous women. Scand J Behav Ther
2001;30:75-84.
39. Alipour Z, Lamyian M, Hajizadeh E, Vafaei MA. The association between antenatal anxiety and fear of
childbirth in nulliparous women: a prospective study. Iran J Nurs Midwifery Res 2011 Spring;16(2):169-73.