Carter Jenny, Tribe Rachel M, Shennan Andrew H, Sandall Jane
Department of Women and Children's Health, King's College London, London, UK.
Department of Women and Children's Health, King's College London, London, UK.
Midwifery. 2018 Sep;64:85-92. doi: 10.1016/j.midw.2018.06.001. Epub 2018 Jun 11.
Preterm birth is a major cause of neonatal death and severe morbidity, so pregnant women experiencing symptoms of threatened preterm labour may be very anxious. The risk assessment and management that follows recognition of threatened preterm labour has the potential to either increase or decrease this anxiety. The aim of this study was to explore women's experience of threatened preterm labour, risk assessment and management in order to identify potential improvements in practice.
One-to-one semi-structured interviews with 19 women who experienced assessment for threatened preterm labour took place between March 2015 and January 2017. A purposive sample approach was employed to ensure participants from different risk and demographic backgrounds were recruited at an inner city UK NHS hospital. Interviews were recorded and transcribed. Data was managed with NVivo software and analysed using the Framework Approach. A public and patient involvement panel contributed to the design, analysis and interpretation of the findings.
Data saturation was achieved after 19 interviews. 11 women were low risk and 8 were high risk for preterm birth. All high risk women had experience of being supported by a specialist preterm team. Four main themes emerged: (i) coping with uncertainty; (ii) dealing with conflicts; (iii) aspects of care and (iv) interactions with professionals. Both low and high risk women experiencing TPTL struggle to cope with the uncertainty of this unpredictable state. The healthcare management they receive can both help and hinder their ability to cope with this extremely stressful experience. High risk women were less likely to receive conflicting advice.
Clinicians should acknowledge uncertainty, minimize conflicting information and advice, and promote continuity of care models for all women, including those attending high risk clinics and in the ward environment.
早产是新生儿死亡和严重发病的主要原因，因此出现先兆早产症状的孕妇可能会非常焦虑。识别先兆早产之后进行的风险评估和管理有可能增加或减少这种焦虑。本研究的目的是探讨女性在先兆早产、风险评估和管理方面的经历，以确定实践中可能的改进之处。
2015年3月至2017年1月期间，对19名经历过先兆早产评估的女性进行了一对一的半结构化访谈。采用目的抽样法，以确保在英国一家市中心的国民保健服务医院招募到来自不同风险和人口背景的参与者。访谈进行了录音和转录。数据使用NVivo软件进行管理，并采用框架法进行分析。一个公众和患者参与小组参与了研究结果的设计、分析和解读。
19次访谈后达到了数据饱和。11名女性为低风险早产，8名女性为高风险早产。所有高风险女性都有得到早产专科团队支持的经历。出现了四个主要主题：（i）应对不确定性；（ii）处理冲突；（iii）护理方面；（iv）与专业人员的互动。经历先兆早产的低风险和高风险女性都难以应对这种不可预测状态的不确定性。她们所接受的医疗管理既有助于也会阻碍她们应对这种极度紧张经历的能力。高风险女性不太可能收到相互矛盾的建议。
临床医生应认识到不确定性，尽量减少相互矛盾的信息和建议，并为所有女性，包括那些在高危门诊就诊的女性和病房环境中的女性，推广连续性护理模式。
