Abstract
Objectives: To determine obstetrical complications in the first ongoing
pregnancy following surgical management of women with Asherman syndrome
(AS) Design: A cohort study conducyed between January 2010 and December
2020 with a minimal follow-up of 1 year. Setting: Study was conducted in
the Asherman Expertise Center a referral center for women with AS.
Population: women with a pregnancy and delivery after hysteroscopic
adhesiolysis for AS Methods: Obstetrical outcomes were assessed using a
follow up questionnaire and obstetrical complications data on the
delivery were collected from the patients’ hospital records. Mean
Outcome Measures: Obsterical outcome in women with AS such as premature
delivery, small for gestational age placenta complications postpartum
problem. Results: We included 425 patients with a first pregnancy of at
least 20 weeks after AS treatment. 407 living children were born, and
there were 16 perinatal death (including 1 set of twins, 3.3%) and 2
terminations of pregnancy (0.5%). Of these women 21.8 % had a
premature delivery, 17% had a baby who was small for gestational age.
Of all women, 17.8% had a placenta complication and 50.6 % had a
postpartum problem. These numbers were worse among women who had a
postpartum procedure as a cause of AS, as 83% of them had postpartum
complications, 33% a premature delivery and 27% placenta
complications. Overall, 53% of women with a first trimester procedure
and 85% of women with a postpartum procedure preceding AS had a severe
adverse obstetric outcome. Conclusions : After successful
adhesiolysis of women with AS, pregnancy should be considered medium to
high risk for complications during pregnancy and postpartum, especially
among women who had a postpartum procedure in their medical history.