Psychological impact of Placenta Accreta Spectrum disorders (PAS) and risk of Post-Traumatic Stress Disorder (PTSD): A cross-sectional study.

OBJECTIVE: Placenta Accreta Spectrum disorders (PAS) are a group of obstetric complications with an increasing incidence. The high maternal and neonatal morbidity and mortality associated with PAS leads to concerns about the negative psychological impact, and even the risk of developing Post-Traumatic Stress Disorder (PTSD). The aim of this study was to assess the psychological impact of PAS diagnosis and intervention during pregnancy and postpartum and its potential association with PTSD. STUDY DESIGN: A cross-sectional study was conducted, including cases of PAS FIGO grade 2 and 3 treated at University Hospital Center São João, between 2010-2023. Only cases with histopathological confirmation after peripartum hysterectomy were included. Data were obtained from electronic medical records (Sclinic® and Obscare®). The impact of Event Scale - Revised (IES-R), a validated questionnaire, was applied, after surgery for PAS, to assess the psychological impact of PAS diagnosis and treatment. RESULTS: Fourteen cases of PAS were identified. The mean maternal age was 36.8 years. Approximately 86 % of cases had antenatal suspicion. The mean gestational age at delivery was 34 weeks. Of the 14 women, only 11 responded to the request to participate in the study (7 interviewed in person and 4 remotely). Four women had IES-R scores indicative of high risk of PTSD (IES-R>33 points), one had an intermediate risk (IES-R between 24-32 points), and 6 fell into the low-risk category. The mean score was 22.4 points. The analysis of IES-R results by clusters showed higher scores in the intrusion category, which relates to intrusive and unwanted thoughts, images and memories. CONCLUSION: Given the high morbidity and mortality described in women with PAS, the risk of PTSD should be acknowledged, motivating early intervention to prevent the development of severe and potentially chronic symptoms. Supportive measures and psychiatric and/or psychological follow-up should be promptly implemented, ideally by multidisciplinary teams.

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

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..

Post traumatic stress disorder (PTSD): The psychological sequelae of abnormally invasive placenta (AIP).

INTRODUCTION: Abnormally invasive placenta (AIP) is a rare pregnancy complication often resulting in postpartum haemorrhage (PPH) and emergency peripartum hysterectomy (EPH). The risk of developing post traumatic stress disorder (PTSD) following unexpectedly traumatic childbirth is known however there is no evidence regarding PTSD in AIP. This pilot study assesses the risk of PTSD for women with AIP compared to women having an uncomplicated caesarean delivery (CD) or unexpected PPH or EPH. METHODS: Retrospective case-controlled questionnaire study in a UK Tertiary obstetric unit. Women with AIP (Group-1) were matched by delivery date to control groups: Group-2, women with an uncomplicated CD; Group-3 women referred to a specialist clinic for suspected AIP, but had a normal placenta and uncomplicated CD; Group-4, women who had an unexpected EPH and/or severe (>3000 mls) PPH. 218 women were sent a validated PTSD screening questionnaire (Impacts of Events Scale-Revised [IES-R]). RESULTS: Likelihood of PTSD was recorded for 69 women who responded, revealing significantly higher PTSD scores for women with AIP compared to uncomplicated CD (P = 0.001). No significant difference was seen between AIP and EPH/PPH (P = 0.89). The number of women with scores high enough to indicate probable PTSD was significantly greater with AIP than uncomplicated CD group (P = 0.045). DISCUSSION: This study demonstrates that women antenatally diagnosed with AIP and anticipating a potentially traumatic delivery, are at significantly increased risk of developing PTSD. Improved awareness of the negative psychological impact of AIP may increase the number of women being identified and treated, thereby improving their quality of life.

Web-based education for placental complications of pregnancy.

OBJECTIVE: The objective of this study was to determine whether a web-based education strategy could improve maternal knowledge of placental complications of pregnancy and reduce maternal anxiety in high risk-pregnancies. METHODS: Prospective study in the Placenta Clinic at Mount Sinai Hospital, Toronto, Ontario. Maternal demographics and Internet usage were recorded at the patient's baseline appointment. Placental knowledge was determined using structured verbal and illustrative assessments. The six-item State-Trait Anxiety Inventory (STAI) was administered to assess baseline maternal anxiety. Women were asked to visit the Placenta Clinic website for a minimum of 15 minutes before their follow-up appointment, at which time their placental knowledge and STAI assessments were repeated. RESULTS: Eighteen women were included in the study. Patient knowledge at the baseline appointment was generally poor (median score 10.5 out of a maximum score of 27, range 1 to 22), with major deficits in basic placental knowledge, placenta previa/increta, and preeclampsia. At the follow-up appointment, placental knowledge was significantly improved (median score 23, range 10 to 27; P < 0.001). Educational status (high school or less vs. college or more) had no effect on either baseline knowledge or knowledge improvement. Maternal anxiety at baseline (median score 12 out of a maximum score of 24, range 6 to 23) was significantly reduced at the follow-up appointment (median score 8.5, range 6 to 20; P = 0.005). CONCLUSION: Deficits in maternal knowledge of placental complications of pregnancy in high-risk pregnant women were substantial but easily rectified with a disease-targeted web-based educational resource. This intervention significantly improved patient knowledge and significantly reduced maternal anxiety.

Objectif : Cette étude avait pour objectif de déterminer si une stratégie pédagogique sur le Web pouvait améliorer les connaissances maternelles en matière de complications placentaires de la grossesse et atténuer l'anxiété maternelle dans le cadre des grossesses exposées à des risques élevés. Méthodes : Tenue d'une étude prospective au sein de la Placenta Clinic du Mount Sinai Hospital à Toronto, en Ontario. Les habitudes d'utilisation d'Internet et les caractéristiques démographiques maternelles ont été consignées au cours de la consultation de départ avec la patiente. Les connaissances quant au placenta ont été déterminées au moyen d'évaluations illustrées et verbales structurées. Le six-item State-Trait Anxiety Inventory (STAI) a été administré pour évaluer l'anxiété maternelle de départ. Nous avons demandé aux femmes de consulter le site Web de la Placenta Clinic pendant un minimum de 15 minutes avant leur consultation de suivi; au cours de celle-ci, leurs connaissances quant au placenta ont été évaluées à nouveau et les évaluations STAI ont été menées une fois de plus. Résultats : Dix-huit femmes ont participé à l'étude. Au moment de la consultation de départ, les connaissances des patientes étaient généralement faibles (score médian de 10,5 sur un score maximal de 27, plage de 1 à 22), des déficits majeurs ayant été constatés en matière de connaissances de base quant au placenta, au placenta prævia/increta et à la prééclampsie. Au moment de la consultation de suivi, les connaissances quant au placenta présentaient une amélioration considérablement accrue (score médian de 23, plage de 10 à 27; P < 0,001). Le niveau de scolarité (études secondaires ou moins vs études postsecondaires ou plus) n'a exercé aucun effet sur l'état des connaissances au départ ni sur l'amélioration des connaissances. L'anxiété maternelle au départ (score médian de 12 sur un score maximal de 24, plage de 6 à 23) avait connu une baisse considérable au moment de la consultation de suivi (score médian de 8,5, plage de 6 à 20; P = 0,005). Conclusion : Les déficits en matière de connaissances maternelles quant aux complications placentaires de la grossesse chez les femmes enceintes exposées à des risques élevés étaient substantiels, mais facilement corrigeables au moyen d'une ressource pédagogique sur le Web axée sur la maladie. Cette intervention a mené à une amélioration significative des connaissances des patientes et à une baisse considérable de l'anxiété maternelle.