Patient-Reported Health Outcomes and Quality of Life after Peripartum Hysterectomy for Placenta Accreta Spectrum

Abstract

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

Transfusion requirements with hybrid management of placenta accreta spectrum incorporating delayed hysterectomy: a retrospective study

“…A randomised trial to answer this question is unlikely. Furthermore, recent data suggest significant patient-reported anxiety, grief, and depression in the setting of PAS [16]. While not studied in the present manuscript, delayed hysterectomy may prolong the risk of a patient's psychological experience with PAS and must be considered.…”

Evaluation of Peripartum Hysterectomy in a Tertiary Care Unit and Its Effect on Patients’ Long-Term Physical and Mental Wellbeing: Quest Is Not Over When You Save the Life

“…A prospective cohort study among women with MAP and who underwent caesarean hysterectomy at Utah revealed that ongoing decreased QOL and long-term health issues for up to 3 years following surgery than those undergoing LSCS for other indications [ 32 ]. At 36 months, women with MAP who underwent PPH were more likely to report grief, depression, anxiety, and additional surgeries.…”

Quality of Life and Sexual Function of Placenta Accreta Spectrum Disorder Patients after Surgery

“…Decreased quality of life was also reported at 12 and 36 months post-hysterectomy in the PAS group. 1 The present study at assessing sexuality after hysterectomy using the Female Sexual Function Index (FSFI) showed that Total FSFI score was 19.4 ± 3.6 (median 19.8) and for the domains: 3.2 ± 0.9 (desire); 3.2 ± 0.9 (arousal); 3.1 ± 0.6 (lubrication); 3.1 ± 0.7 (orgasm); 3.5 ± 1.1 (satisfaction) and 3.2 ± 1.2 (pain/dyspareunia). All women displayed sexual dysfunction (total FSFI score ≤ 26.55).…”

“…When this condition is diagnosed antenatally and women are referred to specialist centres for delivery, the outcome improves signifi cantly. 1 In women with a fi nal diagnosis of placenta increta or percreta, the antenatal diagnosis is associated with reduced bleeding rates and reduced need for blood transfusions, possibly because women diagnosed antenatally are more likely to have preventive therapy for bleeding, and are less likely to attempt to remove their placenta. In addition, more than half of women with placenta accreta, increta, or percreta underwent hysterectomy.…”

“…These long-term effects may be related to several factors including a wider surgical dissection leading to increased scarring and increased emotional burden caused by hysterectomy, loss of fertility. 1 When patients choose a hysterectomy, they should be counselled by their doctor about their medical condition, reasons for surgery, planned surgical procedures, the expected recovery process, and potential long-term problems. Theoretically, removal of the uterus has the potential to affect the pelvic anatomical structures including the regional nerve supply.…”