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我们的孩子并非一种诊断结果:产前诊断为13三体或18三体后仍继续妊娠的父母的经历。

Our children are not a diagnosis: the experience of parents who continue their pregnancy after a prenatal diagnosis of trisomy 13 or 18.

作者信息

Guon Jennifer, Wilfond Benjamin S, Farlow Barbara, Brazg Tracy, Janvier Annie

机构信息

Kaiser Permanente, Panorama City, California.

出版信息

Am J Med Genet A. 2014 Feb;164A(2):308-18. doi: 10.1002/ajmg.a.36298. Epub 2013 Dec 5.

Abstract

Trisomy 13 and trisomy 18 (T13-18) are associated with high rates of perinatal death and with severe disability among survivors. Prenatal diagnosis (PND) may lead many women to terminate their pregnancy but some women choose to continue their pregnancy. We sent 503 invitations to answer a questionnaire to parents who belong to T13 and 18 internet support groups. Using mixed methods, we asked parents about their prenatal experience, their hopes, the life of their affected child, and their family experience. 332 parents answered questions about 272 children; 128 experienced PND. These parents, despite feeling pressure to terminate (61%) and being told that their baby would likely die before birth (94%), chose to continue the pregnancy. Their reasons included: moral beliefs (68%), child-centered reasons (64%), religious beliefs (48%), parent-centered reasons (28%), and practical reasons (6%). At the time of the diagnosis, most of these parents (80%) hoped to meet their child alive. By the time of birth, 25% chose a plan of full interventions. A choice of interventions at birth was associated with fewer major anomalies (P < 0.05). Parents describe "Special" healthcare providers as those who gave balanced and personalized information, respected their choice, and provided support. Parents make decisions to continue a pregnancy and choose a plan of care for their child according to their beliefs and their child's specific medical condition, respectively. Insights from parents' perspective can better enable healthcare providers to counsel and support families.

摘要

13三体和18三体(T13 - 18)与围产期高死亡率以及存活者中的严重残疾相关。产前诊断(PND)可能导致许多女性终止妊娠,但有些女性选择继续妊娠。我们向属于13三体和18三体互联网支持小组的家长发送了503份问卷邀请。我们采用混合方法,询问家长他们的产前经历、期望、患病孩子的生活以及家庭经历。332位家长回答了关于272名孩子的问题;其中128位经历了产前诊断。这些家长尽管感到有终止妊娠的压力(61%),并且被告知他们的宝宝很可能在出生前死亡(94%),但仍选择继续妊娠。他们的理由包括:道德信念(68%)、以孩子为中心的理由(64%)、宗教信仰(48%)、以家长为中心的理由(28%)以及实际理由(6%)。在诊断时,这些家长中的大多数(80%)希望能活着见到自己的孩子。到出生时,25%的家长选择了全面干预的方案。出生时选择干预方案与较少的严重畸形相关(P < 0.05)。家长们将“特别的”医疗服务提供者描述为那些能提供平衡且个性化信息、尊重他们的选择并给予支持的人。家长们分别根据自己的信念和孩子的具体病情做出继续妊娠的决定以及为孩子选择护理方案。从家长角度获得的见解能够更好地帮助医疗服务提供者为家庭提供咨询和支持。

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