Abstract

OBJECTIVE
To study fetal-maternal outcomes in pregnancies following hysteroscopic treatment of Asherman Syndrome (AS) compared to pregnancies without a history of AS. A secondary objective was to examine whether outcomes varied based on AS characteristics.

DESIGN
A propensity score-matched cohort study conducted at a tertiary referral center between January 2011 and December 2022.

SUBJECTS
The study included 428 women treated for AS who subsequently achieved a viable pregnancy (>22 weeks gestation) and 2145 matched comparison group without a history of AS.

EXPOSURE
Women underwent hysteroscopic adhesiolysis for AS, followed by standardized postoperative care, including intrauterine device placement and hormonal treatment. Propensity score matching was applied to control for age, calendar year, parity, and gravidity.

MAIN OUTCOME MEASURES
The primary outcomes included perinatal death, preterm delivery, breech presentation, birth weight, manual removal of the placenta, and mode of delivery and postpartum hemorrhage.

RESULTS
Women with a history of AS experienced statistically significantly higher risks of adverse fetal maternal outcomes compared to the comparison group. Twelve perinatal deaths (OR 3.8; 95%CI 1.8-8.2) occurred in the AS cohort, primarily associated with extreme prematurity. Furthermore, outcomes included increased risks of preterm birth (OR 3.14;95% CI (2.31-4.26) breech presentation (OR 3.57; 95% CI, 2.44-5.23) and postpartum hemorrhage (OR 2.52; 95% CI, 1.95-3.25). The likelihood of manual removal of the placenta was eightfold higher (OR 8.5; 95% CI, 6.2-11.7). While birth weight was lower in the AS group, this was largely due to prematurity, with no observed increase in small for gestational age infants. Subgroup analyses revealed the highest risk in women with a postpartum procedure preceding AS and those with severe adhesions.

CONCLUSION
Pregnancies following hysteroscopic treatment for AS are associated with statistically significantly increased risks of fetal maternal complications. These findings highlight the need for specialized prenatal care and risk management for women with AS. This study underscores the importance of developing clinical guidelines to optimize pregnancy outcomes in this high-risk population.

Copyright © 2025. Published by Elsevier Inc.