TY - JOUR
T1 - Incidence and Clinical Implications of Placenta Accreta Spectrum after Treatment for Asherman Syndrome
AU - Tavcar, Jovana
AU - Movilla, Peter
AU - Carusi, Daniela A.
AU - Loring, Megan
AU - Reddy, Himabindu
AU - Isaacson, Keith
AU - Morris, Stephanie N.
N1 - Publisher Copyright:
© 2022 AAGL
PY - 2023/3
Y1 - 2023/3
N2 - Study Objective: To investigate the incidence, predictors, and clinical implications of placenta accreta spectrum (PAS) in pregnancies after hysteroscopic treatment for Asherman syndrome (AS). Design: This is a retrospective cohort study, conducted through a telephone survey and chart review. Setting: Minimally invasive gynecologic surgery center in an academic community hospital. Patients: Database of 355 patients hysteroscopically treated for AS over 4 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. Interventions: Telephone survey. Measurements and Main Results: We identified 97 patients meeting the inclusion criteria. Among these patients, 23 (23.7%) patients had PAS. History of cesarean delivery was the only variable statistically significantly associated with having PAS (adjusted odds ratio 4.03, 95% confidence interval 1.31–12.39). PAS was diagnosed antenatally in 3 patients (14.3%), with patients having placenta previa more likely to be diagnosed (p <.01). Nine patients (39.13%) with PAS required cesarean hysterectomy, which is 9.3% of those with a pregnancy that progressed past the first trimester. Factors associated with cesarean hysterectomy were the etiology of AS (dilation and evacuation after the second trimester pregnancy or postpartum instrumentation, p <.01), invasive placenta (increta or percreta, p <.05), and history of morbidly adherent placenta in previous pregnancies (p <.05). Two patients with PAS (9.5%) had uterine rupture, and another 2 (9.5%) experienced uterine inversion. Conclusion: There is a high incidence of PAS and associated morbidity in pregnancies after hysteroscopic treatment for AS. 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.
AB - Study Objective: To investigate the incidence, predictors, and clinical implications of placenta accreta spectrum (PAS) in pregnancies after hysteroscopic treatment for Asherman syndrome (AS). Design: This is a retrospective cohort study, conducted through a telephone survey and chart review. Setting: Minimally invasive gynecologic surgery center in an academic community hospital. Patients: Database of 355 patients hysteroscopically treated for AS over 4 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. Interventions: Telephone survey. Measurements and Main Results: We identified 97 patients meeting the inclusion criteria. Among these patients, 23 (23.7%) patients had PAS. History of cesarean delivery was the only variable statistically significantly associated with having PAS (adjusted odds ratio 4.03, 95% confidence interval 1.31–12.39). PAS was diagnosed antenatally in 3 patients (14.3%), with patients having placenta previa more likely to be diagnosed (p <.01). Nine patients (39.13%) with PAS required cesarean hysterectomy, which is 9.3% of those with a pregnancy that progressed past the first trimester. Factors associated with cesarean hysterectomy were the etiology of AS (dilation and evacuation after the second trimester pregnancy or postpartum instrumentation, p <.01), invasive placenta (increta or percreta, p <.05), and history of morbidly adherent placenta in previous pregnancies (p <.05). Two patients with PAS (9.5%) had uterine rupture, and another 2 (9.5%) experienced uterine inversion. Conclusion: There is a high incidence of PAS and associated morbidity in pregnancies after hysteroscopic treatment for AS. 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.
KW - Abnormal placentation
KW - Hysteroscopy
KW - Intrauterine adhesions
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U2 - 10.1016/j.jmig.2022.11.013
DO - 10.1016/j.jmig.2022.11.013
M3 - Article
C2 - 36442752
AN - SCOPUS:85144285686
SN - 1553-4650
VL - 30
SP - 192
EP - 198
JO - Journal of Minimally Invasive Gynecology
JF - Journal of Minimally Invasive Gynecology
IS - 3
ER -