Long time interval from surgery to pregnancy is associated with placenta accreta spectrum (PAS) in the post-operative women with intrauterine adhesion (IUA)

Abstract

Abstract Purpose Placenta accreta spectrum (PAS), including placenta increta, placenta percreta, and placenta accreta, is known as morbidly adherent placenta. It is supposed that defective wound healing of endometrium, existing in the short interval pregnancy, will result in the prevalence of PAS. However, the impact of time interval from hysteroscopic surgery to pregnancy on PAS was unknown in the women with intrauterine adhesion (IUA). Methods We conducted a retrospective study in which patients diagnosed with IUA and underwent hysteroscopic adhesion lysis and wishing further fertility simultaneously. Clinical data were obtained from electronic medical records and telephone interviews. Results A total of 102 patients with IUA achieved successful pregnancy. 55 (53.9%) women were diagnosed with PAS and 47 (46.1%) without. 8 (7.8%) women with PAS were miscarriage. Both the severity of adhesions (p = 0.000) and in-vitro fertilization (IVF) (p = 0.003) were demonstrated as risk factors for PAS. Patients with PAS were significantly more likely to suffer from oligohydramnion (p = 0.035), preterm labor (p = 0.001), larger volume of postpartum hemorrhage (p = 0.000), lower birth weight of newborns (p = 0.005). The average time from surgery to pregnancy in the PAS group was significantly longer than that in the non-PAS group (p = 0.000). Interval time between 12 and 24 months was closely related to the higher rate of PAS (OR = 6.8, 95%CI 2.7–17.0, p = 0.000). A Kaplan–Meier analysis also confirmed the significant association between time interval and the prevalence of PAS (p = 0.000). Conclusion The current study demonstrates the severity of IUA and pregnancy achieved by IVF are worse prognoses for the prevalence of PAS. The pregnancies complicated by PAS often get a higher risk of oligohydramnios, postpartum hemorrhage, preterm labor and lower birth weight. Women diagnosed with IUA should achieve pregnancy as soon as possible if treated by hysteroscopic interference.