Available online 26 November 2022

To investigate the incidence, predictors and clinical implications of placenta accreta spectrum (PAS) in pregnancies after hysteroscopic treatment for Asherman syndrome.

This is a retrospective cohort study, conducted through a telephone survey and chart review.

Minimally invasive gynecologic surgery center in an academic community hospital.

Database of 355 patients hysteroscopically treated for Asherman syndrome, over four years. We identified patients who achieved pregnancy past the first trimester and evaluated the incidence and predictors for PAS, as well as associated clinical implications.

Telephone survey

We identified 97 patients meeting the inclusion criteria. Among these patients, 23 (23.7%) patients had PAS. History of cesarean section was the only variable statistically significantly associated with having PAS (adjusted OR 4.03, 95% CI 1.31-12.39). PAS was diagnosed antenatally in three patients (14.3%), with patients having placenta previa more likely to be diagnosed (P<0.01). Nine patients (39.13%) with PAS required cesarean hysterectomy, which is 9.3% of those with a pregnancy that progressed past first trimester. Factors associated with cesarean hysterectomy were the etiology of Asherman syndrome (dilation and evacuation after the second trimester pregnancy or postpartum instrumentation, p<0.01), invasive placenta (increta or percreta, p<0.05) and history of morbidly adherent placenta in previous pregnancies (p<0.05). Two PAS patients (9.5%) had uterine rupture, and another two (9.5%) experienced uterine inversion.

There is a high incidence of PAS and associated morbidity in pregnancies following hysteroscopic treatment for Asherman syndrome. There is a low rate of antenatal diagnosis as well as a lack of reliable clinical predictors, which both stress the importance of clinical awareness, careful counseling and delivery planning.

abnormal placentation

hysteroscopy

intrauterine adhesions

© 2022 Published by Elsevier Inc. on behalf of AAGL.