PDF(Pubmed)
Abstract：
OBJECTIVE: This qualitative focus group study aims to asses cerclage-related symptoms, the impact of a cerclage on daily functioning and patient perspectives of their healthcare experience. This study extends beyond the current focus on surgical and obstetric outcomes of a cerclage, thereby contributing to a more comprehensive understanding of the challenges faced by individuals in the context of extreme preterm birth and fetal loss and the impact of a cerclage on multiple facets in life.
METHODS: Participants were recruited from the Amsterdam University Medical Center, Amsterdam, the Netherlands or via the website of a Dutch patient organization for (extreme) preterm birth. Eligible participants were ≥ 18 years old with a previous vaginal and/or abdominal cerclage with a subsequent delivery at ≥ 34 weeks of gestation with neonatal survival. Two focus group discussions (FGD) were performed. A predefined format was used, which was identical for both the vaginal and abdominal cerclage group. The International Classification of Functioning, Disability and Health (ICF-DH) was used to provide structure. Outcomes were a broad range of participants reported perspectives on physical, emotional, and social-related quality of life.
RESULTS: In the Vaginal Cerclage Group (VCG) and Abdominal Cerclage Group (ACG), respectively, 11 and 8 participants were included. Fear for a subsequent pregnancy loss was the most limiting factor to perform daily activities during pregnancy in all participants with a cerclage. Fear to conceive again because of prior second-trimester fetal loss was experienced by 27% in the VCG and 13% in the ACG. The majority of participants experienced a reduction in anxiety after placement of their cerclage (VCG = 64%, ACG = 75%). Decreased mobility/bedrest (VCG = 100%, ACG = 75%) and blood loss (VCG = 55%, ACG = 13%) were frequently mentioned complaints during pregnancy with cerclage. Other aspects mentioned in both groups were social isolation, the lack of societal participation, and the perceived need to quit work and sports. All participants in the abdominal cerclage group reported a lack of comprehensible and unambiguous information about obstetric management and expectations during pregnancy in secondary care hospitals. Clear communication between secondary and tertiary care hospitals about obstetric management following an abdominal cerclage, for example, about the need for cervical length measurements by ultrasound, the need for bedrest or advice concerning sexual activity was missing (63%). Psychologic support was desired in half of all participants, but was not offered to them.
CONCLUSIONS: The fear of a subsequent pregnancy loss was reported as the most limiting factor in daily life by all participants. Cerclage placement resulted in the reduction of anxiety. Participants mentioned a significant impact of bedrest and activity restriction during pregnancy with cerclage on social participation and daily activities. Unfortunately, no high level evidence is available on this matter. Patients might even benefit from appropriate levels of physical activity throughout their pregnancy to promote their overall well-being. More evidence is needed to determine the optimal level of physical activity. There is a need for clear and unambiguous patient information about obstetric management.
METHODS: Participants were recruited from the Amsterdam University Medical Center, Amsterdam, the Netherlands or via the website of a Dutch patient organization for (extreme) preterm birth. Eligible participants were ≥ 18 years old with a previous vaginal and/or abdominal cerclage with a subsequent delivery at ≥ 34 weeks of gestation with neonatal survival. Two focus group discussions (FGD) were performed. A predefined format was used, which was identical for both the vaginal and abdominal cerclage group. The International Classification of Functioning, Disability and Health (ICF-DH) was used to provide structure. Outcomes were a broad range of participants reported perspectives on physical, emotional, and social-related quality of life.
RESULTS: In the Vaginal Cerclage Group (VCG) and Abdominal Cerclage Group (ACG), respectively, 11 and 8 participants were included. Fear for a subsequent pregnancy loss was the most limiting factor to perform daily activities during pregnancy in all participants with a cerclage. Fear to conceive again because of prior second-trimester fetal loss was experienced by 27% in the VCG and 13% in the ACG. The majority of participants experienced a reduction in anxiety after placement of their cerclage (VCG = 64%, ACG = 75%). Decreased mobility/bedrest (VCG = 100%, ACG = 75%) and blood loss (VCG = 55%, ACG = 13%) were frequently mentioned complaints during pregnancy with cerclage. Other aspects mentioned in both groups were social isolation, the lack of societal participation, and the perceived need to quit work and sports. All participants in the abdominal cerclage group reported a lack of comprehensible and unambiguous information about obstetric management and expectations during pregnancy in secondary care hospitals. Clear communication between secondary and tertiary care hospitals about obstetric management following an abdominal cerclage, for example, about the need for cervical length measurements by ultrasound, the need for bedrest or advice concerning sexual activity was missing (63%). Psychologic support was desired in half of all participants, but was not offered to them.
CONCLUSIONS: The fear of a subsequent pregnancy loss was reported as the most limiting factor in daily life by all participants. Cerclage placement resulted in the reduction of anxiety. Participants mentioned a significant impact of bedrest and activity restriction during pregnancy with cerclage on social participation and daily activities. Unfortunately, no high level evidence is available on this matter. Patients might even benefit from appropriate levels of physical activity throughout their pregnancy to promote their overall well-being. More evidence is needed to determine the optimal level of physical activity. There is a need for clear and unambiguous patient information about obstetric management.
摘要：
目的：这项定性焦点小组研究旨在研究与环扎相关的症状，环扎术对日常功能的影响以及患者对其医疗保健体验的看法。这项研究超出了目前对环扎术的手术和产科结果的关注，从而有助于更全面地理解在极端早产和胎儿丧失的背景下个体所面临的挑战，以及环扎对生活中多个方面的影响。
方法：参与者从阿姆斯特丹大学医学中心招募，阿姆斯特丹,荷兰或通过荷兰患者组织的网站（极端）早产。符合条件的参与者年龄≥18岁，先前有阴道和/或腹部环扎术，随后在妊娠≥34周时分娩，新生儿存活。进行了两个焦点小组讨论(FGD)。使用了预定义的格式，这是相同的阴道和腹部环扎组。国际功能分类，残疾和健康（ICF-DH）用于提供结构。结果是广泛的参与者报告了关于身体的观点，情感,和社会相关的生活质量。
结果：在阴道环扎组（VCG）和腹部环扎组（ACG）中，分别,包括11名和8名参与者。在所有患有环扎术的参与者中，对随后的妊娠失败的恐惧是怀孕期间进行日常活动的最大限制因素。由于先前的孕中期胎儿丢失，VCG中的27％和ACG中的13％经历了再次怀孕的恐惧。大多数参与者在放置环扎后焦虑减轻（VCG=64％，ACG=75%)。行动能力降低/卧床休息(VCG=100%,ACG=75%)和失血(VCG=55%，ACG=13％）在怀孕期间经常被提及环扎术。两组中提到的其他方面是社会隔离，缺乏社会参与，以及人们认为需要放弃工作和运动。腹部环扎组的所有参与者报告缺乏有关二级保健医院怀孕期间产科管理和期望的可理解和明确的信息。二级和三级护理医院之间关于腹部环扎术后产科管理的明确沟通，例如,关于用超声波测量宫颈长度的需要，没有必要卧床休息或提供有关性活动的建议（63％）。一半的参与者需要心理支持，但没有提供给他们。
结论：所有参与者都报告说，对随后怀孕失败的恐惧是日常生活中最大的限制因素。环扎术放置可减少焦虑。参与者提到了怀孕期间卧床休息和活动限制对社会参与和日常活动的重大影响。不幸的是,在这个问题上没有高水平的证据。患者甚至可以在整个怀孕期间从适当水平的体育锻炼中受益，以促进他们的整体健康。需要更多的证据来确定最佳的体力活动水平。需要有关产科管理的明确和明确的患者信息。
方法：参与者从阿姆斯特丹大学医学中心招募，阿姆斯特丹,荷兰或通过荷兰患者组织的网站（极端）早产。符合条件的参与者年龄≥18岁，先前有阴道和/或腹部环扎术，随后在妊娠≥34周时分娩，新生儿存活。进行了两个焦点小组讨论(FGD)。使用了预定义的格式，这是相同的阴道和腹部环扎组。国际功能分类，残疾和健康（ICF-DH）用于提供结构。结果是广泛的参与者报告了关于身体的观点，情感,和社会相关的生活质量。
结果：在阴道环扎组（VCG）和腹部环扎组（ACG）中，分别,包括11名和8名参与者。在所有患有环扎术的参与者中，对随后的妊娠失败的恐惧是怀孕期间进行日常活动的最大限制因素。由于先前的孕中期胎儿丢失，VCG中的27％和ACG中的13％经历了再次怀孕的恐惧。大多数参与者在放置环扎后焦虑减轻（VCG=64％，ACG=75%)。行动能力降低/卧床休息(VCG=100%,ACG=75%)和失血(VCG=55%，ACG=13％）在怀孕期间经常被提及环扎术。两组中提到的其他方面是社会隔离，缺乏社会参与，以及人们认为需要放弃工作和运动。腹部环扎组的所有参与者报告缺乏有关二级保健医院怀孕期间产科管理和期望的可理解和明确的信息。二级和三级护理医院之间关于腹部环扎术后产科管理的明确沟通，例如,关于用超声波测量宫颈长度的需要，没有必要卧床休息或提供有关性活动的建议（63％）。一半的参与者需要心理支持，但没有提供给他们。
结论：所有参与者都报告说，对随后怀孕失败的恐惧是日常生活中最大的限制因素。环扎术放置可减少焦虑。参与者提到了怀孕期间卧床休息和活动限制对社会参与和日常活动的重大影响。不幸的是,在这个问题上没有高水平的证据。患者甚至可以在整个怀孕期间从适当水平的体育锻炼中受益，以促进他们的整体健康。需要更多的证据来确定最佳的体力活动水平。需要有关产科管理的明确和明确的患者信息。
