Objective Short-term morbidity of placenta accreta spectrum (PAS) is well described, but few data are available regarding long-term outcomes and quality of life. We aimed to evaluate patient-reported outcomes after hysterectomy for PAS. Study Design This is a prospective cohort study of women with risk factors for PAS who were enrolled antenatally. Exposed women were defined as those who underwent cesarean hysterectomy due to PAS. Unexposed women were those with three or more prior cesareans or placenta previa, but no PAS, who underwent cesarean delivery without hysterectomy. Two surveys were sent to patients at 6, 12, 24, and 36 months postpartum: (1) a general health questionnaire and (2) the SF-36, a validated quality of life survey. Aggregate scores for each questionnaire were calculated and responses were analyzed. Results At 6 months postpartum, women with PAS were more likely to report rehospitalization (odds ratio [OR] 5.83, 95% confidence interval [CI] 1.40–24.3), painful intercourse (OR 2.50, 95% CI 1.04–6.02), and anxiety/worry (OR 3.77, 95% CI 1.43–9.93), but were not statistically more likely to report additional surgeries (OR 3.39, 95% CI 0.99–11.7) or grief and depression (OR 2.45, 95% CI 0.87–6.95). At 12 months, women with PAS were more likely to report painful intercourse, grief/depression, and anxiety/worry. At 36 months, women with PAS were more likely to report grief/depression, anxiety/worry, and additional surgeries. Women with PAS reported significantly lower quality of life in physical functioning, role functioning, social functioning, and pain at 6 months postpartum, but not in other quality of life domains. Decreased quality of life was also reported at 12 and 36 months in the PAS group. Conclusion Women with PAS are more likely to report ongoing long-term health issues and decreased quality of life for up to 3 years following surgery than those undergoing cesarean for other indications. Key Points

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INTRODUCTION: Peripartum hysterectomy is associated with maternal morbidity, including blood transfusions and ICU admission. The impact of this morbidity on breastfeeding has not been documented. Our objective was to assess self-reported breastfeeding and overall satisfaction in women with peripartum hysterectomy. METHODS: Cohort study comparing women with peripartum hysterectomy to complicated cesarean section. Exposed women were those with hysterectomy due to placenta accreta or atony. Unexposed women were those with complicated cesarean (three or more prior cesareans or placenta previa) who did not have a hysterectomy. Women were enrolled at time of diagnosis or delivery. Details of the delivery hospitalization were abstracted. Breastfeeding surveys were sent to patients at twelve months or more postpartum. Proportions were analyzed with chi-square, Fisher exact, and t-tests. RESULTS: At 12 months postpartum, 69 (39%) of 178 women enrolled completed the follow-up questionnaire. Women with peripartum hysterectomy had higher rates of preterm birth, EBL > 1500cc, ICU admissions, blood transfusion, and NICU admissions compared to those with complicated cesarean section. Similar rates of breastfeeding were found at 6 months (64% vs 74%, P=.40) and 12 months (52% vs 60%, P=.55) postpartum as well as access to lactation consults (64% vs 60%, P=.72) between groups. Women who had a peripartum hysterectomy were less likely to be satisfied with their breastfeeding experience compared to women who had complicated cesarean section (48% vs 76%, P=.02). CONCLUSION: Women who undergo peripartum hysterectomy have higher rates of dissatisfaction with breastfeeding experience at 12 month postpartum compared to those with complicated cesarean sections.