Impact of placenta accreta spectrum and cesarean hysterectomy on quality of life and postpartum depression: a case-control study in Shiraz, Iran

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Abstract
Placenta accreta spectrum (PAS) is an increasingly prevalent condition in women, often necessitating cesarean hysterectomy, which can significantly impact various aspects of life. This study aimed to evaluate the quality of life and postpartum depression in women with PAS and compare them with women who underwent repeated cesarean sections. In this case-control study, we conducted interviews with women after delivery. The SF-36 questionnaire was used to assess quality of life, and the Edinburgh Postnatal Depression Scale (EPDS) was used to assess postpartum depression. Data on demographics, neonatal outcomes, complications, rehospitalization, blood loss, ICU admission, and neonatal NICU admission were collected from hospital records. All data were entered into SPSS and analyzed using descriptive statistics, the Kruskal-Wallis test, Spearman's Rho correlation, the Mann-Whitney U test, and post hoc tests. Among 62 cases with PAS and cesarean hysterectomy and 75 control subjects with repeated cesarean sections, there was a significant difference between the groups in the physical function and pain domains of the SF-36, with lower scores observed in the case group (p-value < 0.001). Significant relationships were found between blood loss and both physical function (p-value = 0.005) and pain (p-value = 0.003). NICU admission was also significantly associated with bodily pain (p-value = 0.01) and physical function (p-value = 0.005). Maternal ICU admission significantly affected physical function (p-value = 0.016), and surgical complications were related to role limitations due to emotional problems (p-value = 0.028). Probable depression was observed in 37 cases and 39 controls(p-value = 0.89). Women with PAS face meaningful postoperative limitations-particularly in physical function and pain-that extend beyond surgical morbidity and highlight the need for specialized perioperative counseling, proactive rehabilitation strategies, and multidisciplinary follow-up. Despite these physical burdens, postpartum depressive symptoms were comparable between groups, indicating that mental health outcomes may depend on factors other than PAS alone.

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