Women with a diagnosis of Placenta Accreta Spectrum (PAS) may experience numerous challenges to their health, both mental and physical. The management of a pregnancy complicated by PAS may involve a long hospital stay, a complex birth with a hysterectomy (removal of the womb) through a large incision on the abdomen, an admission to high dependency or intensive care, and the possibility of their baby being admitted to the special care unit. Hence it follows that women may experience a deterioration in both their physical and mental health after what for many women is a challenging pregnancy. However, there are only a small number of studies that have explored the effects a pregnancy complicated by PAS has on women’s physical and mental health. In order to delve into this relatively unfamiliar area, we carried out a survey study for women who had experienced a pregnancy complicated by PAS. Women were approached to take part through two patient advocacy and support groups; Placenta Accreta Ireland and The National Accreta Foundation (based in the United States).
142 women from various parts of the world took part and completed the survey. Women filled out two questionnaires which are used to assess quality of life. The first questionnaire (Short Form - 36) consists of 36 questions which focus on physical and mental health and how this affects a person’s daily life; the second survey explores sexual health (Female Sexual Function Index). For both questionnaires, participants are given an overall score, with higher scores indicating higher quality of life.
The study had two main aims: firstly, to compare the scores for women depending on their pregnancy outcomes, such as women who had a hysterectomy versus those who retained their womb, or those who had a emergency delivery compared to women who had a planned delivery. Secondly, we compared women’s scores at various time points since the birth; women who were less than 6 months since birth were compared to women who were more than 6 months or years after their pregnancy.
For pregnancy outcomes, we found women who were re-admitted to hospital within 6 weeks of delivery had lower general health scores compared to those who did not require re-admission. Interestingly, women who had a hysterectomy did not have lower mental, physical or sexual health scores compared to women who retained their womb. Furthermore, no other pregnancy outcomes such as being diagnosed during the pregnancy rather than at the time of delivery or later, having a planned delivery compared to an emergency delivery or needing a blood transfusion influenced quality of life or sexual health scores.
Comparing women’s scores at different time points since the birth, we found women’s physical health scores were lowest in the first 6 months postnatal. Physical health scores significantly improved over time, with women at more than 2 years after their pregnancy having the highest scores. Mental health scores, however, were low in the first 6 months postnatal and did not improve much over time.
Overall, we found that pregnancy outcomes such as removal of the womb or an emergency delivery did not worsen mental and physical health scores. Rather, all women had low mental and physical health scores initially after the birth, regardless of if their pregnancy was “more or less” complicated. However, women’s physical health improved greatly in the months and years after the birth. In contrast, women’s mental health scores were lower compared to physical health in the short term postpartum period and there was no improvement in the long-term.
written by Dr Helena Bartels
Click here to read the abstract for this study, or to find links to the full text