照顧一經人工生殖致多胞胎妊娠之不孕症婦女減胎的護理經驗

Experience of Nursing an Infertile Woman Who Had a Multiple Pregnancy and Underwent Fetal Reduction after Receiving Treatment by Assisted Reproductive Technology

接受人工生殖科技治療後懷孕婦女，比自然孕婦女具有較高比率的多胞胎懷孕率，為了提高胎兒存活率，她們往往需要接受減胎術。這些先前不孕的婦女，在治療過程中可能已經存在懷孕失敗或不孕期孤獨感等負向情感，若未妥善處理，可能影響孕期的健康狀況。本文個案為一位28歲不孕症患者，經多次人工生殖科技的協助順利懷有三胞胎後，因妊娠初期併懷疑先兆性流產而入院求治。筆者在照顧個案期間（89.4.21-4.27）發現其自醫師解釋需做減胎手術後，即出現抉擇衝突與低自尊情緒反應，而筆者於護理過程中運用主動關懷、同理心對待，並提供有關產科的專業知識及諮詢機會，並經由有效溝通以改善其對減胎術的負向感受，同時藉由鼓勵個案回想周圍的人事物對個案的依賴與重視以重建其自尊。筆者希望藉此護理經驗及文獻探討之分享以提供護理同仁日後照顧類似病患時，除了給予產前身體症狀的護理外，亦能垂視負向情感症狀之問題，以達完整性之照顧。

Women receiving treatment by assisted reproductive technology (ART) have more risk of multiple pregnancies than those with natural conception. When suffering from multiple pregnancies, they often seek fetal reduction to increase fetal survival rate. Possible pre-existing negative emotions from previous conception failure and feelings of helplessness, if not properly released, will influence well-being throughout the course of the pregnancy. The 28-year-old woman described, a victim of triplet pregnancy after many trials of ART, was admitted to the ward due to threatened abortion. During her period in the hospital (from April 21 to April 27, 1990), she suffered decision conflict and low-self-esteem emotional response when it was suggested by her attending doctor that she should undergo fetal reduction. Through our active caring with sympathy, provision of counseling and knowledge, effective communication to decrease negative feelings regarding fetal reduction, and encouragement to recall her importance to those close to her, she rebuilt her self-esteem. The case report is accompanied by a literature review. This experience is presented as an example for future care in similar situations. Besides routine prenatal nursing care, the problem of negative emotions should be stressed and solved to achieve complete treatment.