(385) Perinatal mental healthcare utilization among patients with placenta accreta spectrum

The psychologial impact of placenta accreta spectrum (PAS) remains understudied. People with PAS face increased risks of fertility loss, morbidity and mortality. Referral to a PAS center and prolonged hospital admission is common.  These stressors place people with PAS at increased risk for perinatal mental health disorders. Since 2017, we’ve universally screened patients once per trimester to identify safety, substance, and psychosocial risks,  referred for care if positive. All PAS patients are offered mental health referral. Patients are referred if they opt-in (accept) a referral. Our objective was to evaluate peripartum mental healthcare utilization within a PAS referral center.

Study Design:

Retrospective cohort of all gravidae with histopathology-confirmed PAS between Jan 2017-Sep 2021. We abstracted data from the medical record: medical history, clinical outcomes, postpartum Edinburgh Postnatal Depression Scale (EPDS) scores (positive screen >10), outpatient psychiatry referral and follow up. Inpatient consults were excluded.  Subjects were grouped by EPDS screen positive vs. negative.  Bivariate analyses were performed.

 

Results: 118 PAS patients were included. 38 (32.2%) had history of mental illness. Median gestational age at delivery was 33 4/7 weeks; neonatal intensive care admission was 86.3%. 24 (20.3%) gravidae had an EPDS score > 10, more often in those with mental illness history. Screen positive patients more often had documented referral, but were no more likely to complete outpatient visits.  Of 42 total referrals, 25 (59.5%) had EPDS < 10. Almost half of mental health appointments were missed. Other maternal, delivery, and neonatal factors did not differ between groups (Table 1).

Conclusion: One in five PAS patients screened positive by EPDS; referral by EPDS alone would have missed patients who desired and utilized mental healthcare visits. Our findings highlight the importance and limitations of mental health screening and the need to identify barriers and additional resources to connect patients with mental health services.