Objectives: Do fetal-maternal complications in the first viable pregnancy after hysteroscopic treatment of Asherman’s syndrome (AS) differ from that of women without AS. Design: We conducted a prospective cohort study utilizing data from patients who underwent AS treatment, enrolled between January 2011 and December 2022 and who consequently conceived and progressed to at least 22 weeks of gestational age. Perinatal outcomes were compared to matched controls without an AS history. Setting: Study was conducted in in a single University-affiliated hospital specialized in AS treatment. This Asherman’s Expertise Center is a tertiary referral center for women with AS. Population: 428 women with the first viable pregnancy after surgical treatment for AS. Out of over 38000 pregnant women, we matched on a 1:5 ratio on age, calendar-year, parity, and gravidity using propensity scores, resulting in a control group of 2120 women. Methods: Chi-square test was used to compare perinatal outcomes between the pairs. The odds ratio (OR) for the associations was calculated by logistic regression including 95% confidence intervals. We performed subgroups analyses to identify whether specific group were at higher risk as compared with others. Mean Outcome Measures: Fetal-Maternal outcome in women who are treated for AS are 1.5 times greater including perinatal death premature delivery, lower average birthweight, breach position and postpartum problems. Results: Women with AS have a fetal-maternal morbidity rate that is one and a half times higher, including more perinatal deaths (2.8% vs 0.7%; P <0.001), premature delivery (20% vs 8%; P<0.001), lower average birthweight 3137gram versus 3361gram (P<0.001), more often a baby in breach position (15.7 vs 5.2%; P<0,001, retained placenta requiring manual or surgical removal (24% vs 4%; P<0.001). Furthermore, significantly greater average total blood loss during delivery (971 ml vs. 622 ml, P<0.001) and a higher incidence of peripartum hemorrhage diagnosis (30% vs. 12%, P<0.001) were observed. Women who undergo a procedure during the postpartum period that leads to AS, exhibit the highest incidence of all perinatal complications. Conclusions : Women diagnosed with AS show a fetal-maternal morbidity rate that is 1.5 times greater, with a higher incidence of perinatal deaths. Women with AS, pregnancy should be considered at high risk for fetal-maternal complications, especially among women who had a postpartum procedure in their medical history.
