Postpartum follow-up and Edinburgh Postnatal Depression Scale scores in prenatally suspected placenta accreta...

To assess the impact of prenatal suspicion of placenta accreta spectrum (PAS) on attendance of postpartum care and Edinburgh Postnatal Depression Scale (EPDS) scores, with stratification by confirmed PAS based on clinical or pathologic PAS grading.

Matched cohort of singleton pregnancies that delivered 2010-2024. Patients with prenatal suspicion of PAS were matched to patients without this concern by age (within 5 years), number of prior cesareans, term or preterm delivery, and hypertensive disorders of pregnancy. Exclusions were fetal anomalies, stillbirth, neonatal death, and those without follow-up data. Maternal demographics, scheduled and attended postpartum follow-up, and EPDS scores were compared between patients with and without prenatal suspicion of PAS. Sub-analysis included confirmed diagnosis of PAS (true positive vs. false positive). Availability of EPDS scores was assessed for all cohorts.

Of 202 patients with prenatally suspected PAS, 112 had available EPDS scores. This was different from patients without this concern where 176 scores were available (55% vs. 87%, p < 0.001). Although patients with prenatally suspected PAS had high rates of follow-up at any postpartum visit (87%), they were more likely to be assigned an additional follow-up visit in our maternal-fetal medicine (66% vs. 18%, p < 0.001), gynecology oncology (14% vs. 0.5%, p < 0.001), urogynecology (6% vs. 0.5%, p < 0.001) clinics and less likely to attend their routine postpartum follow-up (59% vs. 88%, p < 0.001), and thus have available EPDS scores. Median EPDS scores were not statistically higher comparing those with and without prenatal suspicion of PAS (3 (1-7) vs. 3 (1-7), p = 0.971) nor when comparing only patients with confirmed PAS to those without suspicion for PAS (3 (1-7) vs. 3 (1-7), p = 0.668) or when comparing patients with clinically or pathologically negative PAS to patients without PAS (3 (1-5) vs. 4 (2-8), p = 0.432)). The percentage of EPDS scores that would require intervention and referral was not different among all cohorts.

Patients with prenatal suspicion of PAS were more frequently assigned additional subspeciality follow-up and less likely to attend their routine postpartum visit and have EPDS scores available. Of patients with prenatally suspected PAS regardless of whether PAS was confirmed, EPDS scores did not differ from patients without this concern. While potentially reassuring, our findings highlight the need for integrated PAS care to address mental health, removing barriers for assessment and enabling referral if indicated.