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阴道分娩并发伤口裂开后会阴缝合与期待治疗(PREVIEW):一项嵌套式定性研究

Perineal resuturing versus expectant management following vaginal delivery complicated by a dehisced wound (PREVIEW): a nested qualitative study.

作者信息

Dudley L, Kettle C, Waterfield J, Ismail Khaled M K

机构信息

The Maternity Centre, Royal Stoke, University Hospitals of North Midlands, Staffordshire, UK.

Faculty of Health Sciences, Staffordshire University, Stafford, UK.

出版信息

BMJ Open. 2017 Feb 10;7(2):e013008. doi: 10.1136/bmjopen-2016-013008.

Abstract

OBJECTIVE

To explore women's lived experiences of a dehisced perineal wound following childbirth and how they felt participating in a pilot and feasibility randomised controlled trial (RCT).

DESIGN

A nested qualitative study using semistructured interviews, underpinned by descriptive phenomenology.

PARTICIPANTS AND SETTING

A purposive sample of six women at 6-9 months postnatal who participated in the RCT were interviewed in their own homes.

RESULTS

Following Giorgi's analytical framework the verbatim transcripts were analysed for key themes. Women's lived experiences revealed 4 emerging themes: (1) Physical impact, with sub-themes focusing upon avoiding infection, perineal pain and the impact of the wound dehiscence upon daily activities; (2) Psychosocial impact, with sub-themes of denial, sense of failure or self-blame, fear, isolation and altered body image; (3) Sexual impact; and (4) Satisfaction with wound healing. A fifth theme 'participating in the RCT' was 'a priori' with sub-themes centred upon understanding the randomisation process, completing the trial questionnaires, attending for hospital appointments and acceptability of the treatment options.

CONCLUSIONS

To the best of our knowledge, this is the first qualitative study to grant women the opportunity to voice their personal experiences of a dehisced perineal wound and their views on the management offered. The powerful testimonies presented disclose the extent of morbidity experienced while also revealing a strong preference for a treatment option.

TRIAL REGISTRATION NUMBER

ISRCTN05754020; results.

摘要

目的

探讨女性产后会阴伤口裂开的生活经历,以及她们参与一项初步可行性随机对照试验(RCT)的感受。

设计

一项嵌套式定性研究,采用半结构化访谈,以描述性现象学为基础。

参与者与研究背景

对6名产后6 - 9个月参与RCT的女性进行了目的抽样,并在她们家中进行访谈。

结果

按照 Giorgi 的分析框架,对逐字记录的访谈文本进行关键主题分析。女性的生活经历揭示了4个新出现的主题:(1)身体影响,子主题集中在避免感染、会阴疼痛以及伤口裂开对日常活动的影响;(2)心理社会影响,子主题包括否认、失败感或自责、恐惧、孤立以及身体形象改变;(3)性方面的影响;(4)对伤口愈合的满意度。第五个主题“参与RCT”是“先验的”,子主题围绕对随机化过程的理解、完成试验问卷、参加医院预约以及治疗方案的可接受性。

结论

据我们所知,这是第一项给予女性机会讲述她们会阴伤口裂开个人经历以及对所提供治疗看法的定性研究。所呈现的有力证词揭示了所经历的发病程度,同时也显示出对一种治疗方案的强烈偏好。

试验注册号

ISRCTN05754020;结果

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/097b/5306502/cd37b57057bb/bmjopen2016013008f01.jpg

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