一位植入性胎盤產婦接受子宮全切除手術之照護經驗

Nursing Experience of a Patient Undergoing a Cesarean Section and Total Hysterectomy for Placenta Accreta

蕭潤勤(Jun-Chin Hsiao)；陳曉玫(Hsiao-Mei Chen)

植入性胎盤 ； 子宮全切除 ； 早產 ； placenta accrete ； premature birth ； total hysterectomy

志為護理-慈濟護理雜誌

22卷6期（2023 / 12 / 01）

110 - 118

繁體中文;英文

本文為一位植入性胎盤產婦接受剖腹產及非預期性子宮全切除之照護過程，術後生理不適且有喪失自我認同及親職壓力問題。收集資料後確立有急性疼痛、身體心像紊亂及照顧者角色緊張等問題；教導可緩解疼痛的方法與止痛藥使用；利用解剖圖說明子宮功能與切除的必要性，偕同案夫給予陪伴支持，教導術後性生活方式並分享相同案例心路歷程；協助瞭解早產兒相關資訊與照護方法，增加親子依附關係及提升照護信心。針對高危險性孕婦可先告知生產過程可能面臨的狀況與相關醫療處置，予以心理準備，提供具保護性、支持性的環境，讓非預期性子宮切除的產婦能抒發女性失去子宮的情緒，協助維持夫妻親密的關係，進而達到更完善的照護品質。

This article describes the care process for a postpartum woman with a placenta accreta who underwent a cesarean section and an unexpected total hysterectomy, experiencing physical discomfort, loss of self-identity, and parental stress after the surgery. After collecting data, issues such as acute pain, body image disturbance, and caregiver role stress were identified. Methods to alleviate pain and the use of pain medication were taught. Anatomical diagrams were used to explain the function of the uterus and the necessity of the hysterectomy. The husband provided support and accompanied the patient throughout the process, and was taught about postoperative sexual lifestyle and shared similar case experiences. Assistance was given to understand premature infants' related information and care methods, to increase parent-child attachment and improve care confidence. For high-risk pregnant women, informing them of the possible conditions and related medical treatments during the delivery process can help them prepare psychologically. Providing a protective and supportive environment allows post-hysterectomy mothers to express emotions related to the loss of the uterus and maintain intimate relationships with their spouses, ultimately achieving better care quality.

1. 早產兒基金會(2019)．早產兒出院後一般性照護。https://www.pbf.org.tw/gtc_04_01_01
2. 翁敏雪、周弘傑(2016)．父母於早產兒住院期間的親職議題及護理．護理雜誌，63(6)，114–119。https://doi.org/10.6224/JN.65.6.114
3. 衛生福利部(2021，4月30日)．2020生產事故救濟報告。https://dep.mohw.gov.tw/DOMA/cp-5059-58136-106.html
4. Afiyah, R. K., Wahyuni, C. U., Prasetyo, B., & Dwi Winarno, D. (2020). Recovery time period and quality of life after hysterectomy. Journal of Public Health Research, 9(2), 1837. https://doi.org/10.4081/jphr.2020.1837
5. Dedden, S. J., van Ditshuizen, M. A. E., Theunissen, M., & Maas, J. W. M. (2020). Hysterectomy and sexual (dys)function: An analysis of sexual dysfunction after hysterectomy and a search for predictive factors. European Journal of Obstetrics & Gynecology and Reproductive Biology, 247 , 80-84. https://doi.org/10.1016/j.ejogrb.2020.01.047
6. Gerstein, E. D., Njoroge, W. F. M., Paul, R. A., Smyser, C. D., & Rogers, C. E. (2019). Maternal depression and stress in the neonatal intensive care unit: Associations with mother-child interactions at age 5 years. Journal of the American Academy of Child & Adolescent Psychiatry, 58 (3), 350-358. https://doi.org/10.1016/j.jaac.2018.08.016
7. Karcioglu, O., Topacoglu, H., Dikme, O., & Dikme, O. (2018). A systematic review of the pain scales in adults: Which to use? American Journal of Emergency Medicine, 36 (4), 707-714. https://doi.org/10.1016/j.ajem.2018.01.008
8. Kogutt, B. K., & Vaught, A. J. (2019). Postpartum hemorrhage: Blood product management and massive transfusion. Seminars in Perinatology, 43 (1), 44-50. https://doi.org/10.1053/j.semperi.2018.11.008
9. Macho, P. (2017). Individualized developmental care in the NICU: A concept analysis. Advances in Neonatal Care, 17 ( 3 ) , 162-174. https://doi.org/10.1097/ANC.0000000000000374
10. Silver, R. M., & Branch, D. W. (2018). Placenta accreta spectrum. The New England Journal of Medicine, 378(16), 1529-1536. https://doi.org/10.1056/NEJMcp1709324
11. World Health Organization. (2019). Maternal mortality. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality