[Analysis of reproductive and psychological health of pregnant women with placenta accreta spectrum disorders after fertility-preserving treatment].

Objective: To analyze the reproductive and psychological health status of pregnant women with placenta accreta spectrum disorders (PAS) after fertile-preserving surgery, and to follow up their subsequent pregnancy and delivery. Methods: A total of 269 cases of abnormally invasive placenta (AIP) who underwent pregnancy supervision and surgical treatment in Peking University First Hospital from January 2010 to August 2020 were collected as AIP group. A total of 300 pregnant women without other complications who underwent elective cesarean section due to cesarean section history in the same center and at the same time period were selected as the control group. Their clinical information was collected, and their menstruation, fertility and psychological health were followed up by telephone and online questionnaire. Results: (1) In AIP group, 222 (82.5%, 222/269) valid questionnaires were returned, of which 171 (77.0%, 171/222) completed the subjective scale. The control group returned 254 valid questionnaires (84.7%, 254/300), of which 191 (75.2%, 191/254) filled in the complete subjective scale. There was no significant difference in the demographic characteristics between AIP group and control group (all P>0.05), but the intraoperative blood loss, the incidence of short-term postoperative complications and the length of hospital stay in AIP group were higher than those in control group. (2) There were no differences in reproductive physiological health status, including the time to resume sexual life, menstruation, re-pregnancy, pelvic ultrasound manifestations and long-term complications between AIP group and control group. The fertility intention of AIP group was lower than that of control group [12.3% (25/204) vs 19.3% (49/254)]. (3) In AIP group, 17 women tried to get pregnant again, and 12 of them (12/17) had successful pregnancy and delivered, and no PAS occurred again. (4) FSFI scores of women undergoing hysterectomy (18 cases) were lower than those undergoing fertive-sparing surgery (204 cases) in AIP group, but there was no differences in the proportion of pelvic floor dysfunction and suspicious emotional disorder. Conclusions: The physiological function of pelvic organs in women with AIP can be restored after fertive-preserving surgery, which is similar to that of women with a history of cesarean section. The risk of pelvic floor dysfunction and emotional disorders is not significantly increased after hysterectomy, but the risk of sexual dysfunction is higher. Hysterectomy is not recommended as the first-line treatment for PAS. Women with fertility desire can get pregnant again and deliver by cesarean section, but PAS should be closely monitored for recurrence during pregnancy.