Impact of placenta accreta spectrum on sexual and psychological health: a comparative analysis using FSFI and SF-36.

BACKGROUND

Placenta accreta spectrum (PAS) is a potentially life-threatening obstetric condition characterized by abnormal placental adherence to the myometrium. While hysterectomy remains the standard definitive management, conservative strategies such as wedge resection or delayed hysterectomy have been increasingly adopted to preserve fertility. The comparative impact of these approaches on women's quality of life (QoL), particularly social and sexual functioning, has not been well investigated.

METHOD: A cross-sectional study included 185 women who underwent caesarean section (CS) for histopathologically confirmed PAS at Dr. Hasan Sadikin General Hospital, Bandung, West Java, from 2022 to 2024. A total of 161 met the inclusion criteria and were analyzed, while 24 were excluded. Sexual function and QoL were assessed using the Female Sexual Function Index (FSFI) and the 36-Item Short Form Health Survey (SF-36), respectively. Non-parametric analysis using the Mann-Whitney U test was applied for scale scores and categorical comparisons were analyzed using Chi-square or Fisher's exact test, with p < 0.05 considered significant.

RESULT: Median FSFI scores for desire (3.0 [2.5-3.5] vs. 3.0 [2.0-4.0], p = 0.015), arousal (2.5 [2.0-3.5] vs. 3.0 [2.0-4.0], p = 0.048), and pain (2.4 [2.0-2.7] vs. 3.0 [2.0-4.0], p = 0.021) differed significantly between the hysterectomy and conservative groups, although median values for desire were similar. Other FSFI domains and total scores were not significantly different (p > 0.05). In the SF-36, a statistically significant difference was observed only in the social functioning domain, despite comparable median scores between groups.

CONCLUSION

Conservative management in PAS was associated with better preservation of specific aspects of sexual function, particularly pain and arousal.