Incidence and Clinical Implications of Placenta Accreta Spectrum (PAS) after Hysteroscopic Treatment for Asherman's Syndrome

Study Objective To investigate the incidence of placenta accreta spectrum (PAS), predictors for malplacentation and clinical implications in pregnancies after hysteroscopic treatment for Asherman syndrome. Design Retrospective cohort study. Setting Minimally invasive gynecologic surgery practice in a community teaching hospital. Patients or Participants 355 patients hysteroscopically treated for Asherman's Syndrome 01/01/2015 - 03/01/2019 Interventions Observational study, retrospectively followed patients after hysteroscopic treatment for Asherman's Syndrome Measurements and Main Results Through telephone survey and confirmatory chart review, we identified 97 patients who achieved pregnancy passed the first trimester, following hysteroscopic treatment for Asherman's Syndrome. Among these patients, 23 (23.71%) 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 (13.04%), with patients having placenta previa more likely to be diagnosed (P Conclusion High incidence of PAS and associated morbidity in pregnancies following hysteroscopic treatment for Asherman's Syndrome, together with the low rate of antenatal diagnosis, stresses the importance of clinical awareness, counseling and delivery planning. Clinicians who treat Asherman's Syndrome, including gynecologic surgeons and reproductive endocrinologists, should properly counsel and empower women to be their own advocates.