Am J Perinatol 2022; 39(03): 281-287
DOI: 10.1055/s-0040-1715465
Original Article

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

Bryan Grover
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
,
Brett D. Einerson
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
2   Intermountain Healthcare, Salt Lake City, Utah
,
Karissa D. Keenan
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
2   Intermountain Healthcare, Salt Lake City, Utah
,
Karen J. Gibbins
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
2   Intermountain Healthcare, Salt Lake City, Utah
,
Emily Callaway
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
,
Sarah Lopez
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
,
Robert M. Silver
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
2   Intermountain Healthcare, Salt Lake City, Utah
› Institutsangaben

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

  • Long-term placenta accreta spectrum data to guide peripartum patient education.

  • This study addresses a critical knowledge gap.

  • Women affected by PAS report long-term morbidity.

Supplementary Material



Publikationsverlauf

Eingereicht: 24. Februar 2020

Angenommen: 07. Juli 2020

Artikel online veröffentlicht:
20. August 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Silver RM, Landon MB, Rouse DJ. et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006; 107 (06) 1226-1232
  • 2 Eller AG, Porter TT, Soisson P, Silver RM. Optimal management strategies for placenta accreta. BJOG 2009; 116 (05) 648-654
  • 3 Bailit JL, Grobman WA, Rice MM. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Morbidly adherent placenta treatments and outcomes. Obstet Gynecol 2015; 125 (03) 683-689
  • 4 Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 1997; 177 (01) 210-214
  • 5 Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 2005; 192 (05) 1458-1461
  • 6 Eller AG, Bennett MA, Sharshiner M. et al. Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care. Obstet Gynecol 2011; 117 (2 Pt 1): 331-337
  • 7 Shamshirsaz AA, Fox KA, Salmanian B. et al. Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Am J Obstet Gynecol 2015; 212 (02) 218.e1-218.e9
  • 8 Tikkanen M, Paavonen J, Loukovaara M, Stefanovic V. Antenatal diagnosis of placenta accreta leads to reduced blood loss. Acta Obstet Gynecol Scand 2011; 90 (10) 1140-1146
  • 9 Harnod T, Chen W, Wang J-H, Lin S-Z, Ding D-C. Hysterectomies are associated with an increased risk of depression: a population-based cohort study. J Clin Med 2018; 7 (10) E366
  • 10 Handelzalts JE, Levy S, Peled Y, Yadid L, Goldzweig G. Mode of delivery, childbirth experience and postpartum sexuality. Arch Gynecol Obstet 2018; 297 (04) 927-932
  • 11 Welz J, Keyver-Paik MD, Gembruch U, Merz WM. Self-reported physical, mental, and reproductive sequelae after treatment of abnormally invasive placenta: a single-center observational study. Arch Gynecol Obstet 2019; 300 (01) 95-101
  • 12 Ayers S, Bond R, Bertullies S, Wijma K. The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework. Psychol Med 2016; 46 (06) 1121-1134
  • 13 Ware Jr JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30 (06) 473-483
  • 14 Ware JE, Snow KK, Kosinski M, Gandek B. SF-36 Health Survey Manual and Interpretation Guide. Boston, MA: New England Medical Center, The Health Institute; 1993
  • 15 Ware Jr JE, Gandek B. Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol 1998; 51 (11) 903-912
  • 16 Health R, Medical R, Study O, Short I, Survey F. . 36-Item Short Form Survey (SF-36) Scoring Instructions RAND. Accessed date February 15, 2020 at: https://www.rand.org/health-care/surveys_tools/mos/36-item-short-form/scoring.html
  • 17 Chang SR, Lin WA, Lin HH, Shyu MK, Lin MI. Sexual dysfunction predicts depressive symptoms during the first 2 years postpartum. Women Birth 2018; 31 (06) e403-e411
  • 18 de la Cruz CZ, Coulter ML, O'Rourke K, Amina Alio P, Daley EM, Mahan CS. Women's experiences, emotional responses, and perceptions of care after emergency peripartum hysterectomy: a qualitative survey of women from 6 months to 3 years postpartum. Birth 2013; 40 (04) 256-263
  • 19 Tol ID, Yousif M, Collins SL. Post traumatic stress disorder (PTSD): the psychological sequelae of abnormally invasive placenta (AIP). Placenta 2019; 81: 42-45