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PubMed This is a summary of 24 peer-reviewed journal articles Updated
Obstetrics · Placenta Accreta Spectrum

How High Is Placenta Accreta Risk After Asherman Treatment?

At a Glance

Treatment for Asherman syndrome is associated with a higher risk of placenta accreta spectrum, but it does not mean you have the condition. Specialist ultrasound monitoring and delivery planning help prepare for severe bleeding if PAS is suspected.

If you became pregnant after being treated for Asherman syndrome, you have a higher risk for a condition called placenta accreta spectrum (PAS). This is why your care team is paying such close attention to your placenta. While many people go on to have healthy pregnancies after treatment, the underlying damage to your uterine lining from Asherman syndrome can sometimes allow the placenta to attach too deeply into the uterine wall [1][2]. Because PAS can cause severe bleeding during delivery, specialized monitoring is critical to keep you and your baby safe [3][4]. Having this history means your team is planning ahead; it does not mean you definitely have PAS.

What is Placenta Accreta Spectrum (PAS)?

During a normal pregnancy, the placenta attaches to a thick, healthy layer of the uterine lining called the decidua. This layer acts as a barrier, regulating how far the placenta can grow into the uterus. When your baby is born, this barrier helps the placenta detach smoothly.

In Asherman syndrome, the deepest layer of the uterine lining has been injured, often replacing healthy tissue with scar tissue [5][6]. Even after your doctor removes the scar tissue (hysteroscopic adhesiolysis), the newly healed lining may remain thin or lack normal blood vessels [7][8].

Without a healthy decidual barrier, the cells that form the placenta may attach abnormally or invade too deeply [5][7]. This creates a spectrum of conditions:

  • Placenta Accreta: The placenta attaches too firmly to the uterine wall.
  • Placenta Increta: The placenta grows into the myometrium (the muscular wall of the uterus).
  • Placenta Percreta: The placenta grows completely through the uterine wall and sometimes into nearby organs like the bladder.

Understanding Your Risk

Research shows an association between a history of Asherman syndrome and an increased risk of PAS [9][10]. A review of multiple observational studies found a pooled PAS rate of about 10.1% in pregnancies following Asherman’s treatment [9], while one specific clinic reported rates up to 23.7% [11]. It is important to know that these numbers are group estimates from specific studies, not a calculation of your personal risk.

Your individual risk depends on your full medical history. Your chances of developing PAS are generally higher if:

  • You had a prior Cesarean section (C-section) or other surgeries on your uterus [11][12].
  • You are diagnosed with placenta previa, a condition where the placenta covers or is very near the internal opening of the cervix [12][13]. The combination of a prior C-section and placenta previa is a particularly strong risk factor for PAS [14][15].
  • You had severe scarring that required multiple surgeries to clear [16][1].
  • Some studies suggest risk may be higher if your uterine lining remained very thin after treatment, though this is not a universal rule [17].

Specialized Monitoring and Care

Because of your history, your doctor will likely refer you to a maternal-fetal medicine (MFM) specialist—an obstetrician who manages high-risk pregnancies [12]. Surveillance is highly individualized based on where your placenta is located and what your ultrasounds show.

A specialist will use detailed ultrasounds (both over the belly and transvaginal) to look for signs of PAS, such as abnormal placental spaces (lacunae) or a thinning of the uterine wall [18][19]. If the ultrasound is unclear or if your placenta is difficult to see, your doctor might recommend an MRI as an additional tool [20][21]. However, MRI is not a routine requirement for everyone, and it cannot perfectly rule out PAS [20][21]. Keep in mind that a normal-looking ultrasound is reassuring, but it cannot completely guarantee that PAS is absent [11][12].

Urgent Warning Signs

PAS often has no symptoms during pregnancy. However, if you experience vaginal bleeding, regular contractions, severe pelvic pain, or fluid leakage, contact your maternity unit or go to the emergency room immediately. Bleeding can be life-threatening, even if your previous ultrasounds looked normal.

What Happens If PAS is Suspected?

If your medical team strongly suspects PAS, they will meticulously plan your delivery at a specialized hospital (a Level III or IV maternal care facility) equipped with a multidisciplinary team, a neonatal intensive care unit (NICU), and the ability to handle massive blood transfusions [22][3].

  • Planned Early Delivery: To avoid the severe bleeding risks associated with going into labor, your doctor will likely plan a C-section before your due date. For stable patients with suspected PAS, this is often scheduled between 34 and 36 weeks of pregnancy, though timing is individualized based on your specific health [23][24]. Your team will discuss giving you steroids to help mature your baby’s lungs before an early delivery.
  • Leaving the Placenta in Place: The most critical safety practice during delivery for severe PAS is that the surgical team will not attempt to pull the placenta out. Forcibly removing a deeply attached placenta can cause catastrophic, life-threatening hemorrhage [11].
  • Cesarean Hysterectomy: Instead of removing the placenta, the standard and safest approach for severe, confirmed PAS is to deliver the baby, leave the placenta attached to the uterus, and immediately perform a hysterectomy (removal of the uterus) [11]. This is a major surgery that results in the permanent loss of the ability to carry another pregnancy. While some uterus-preserving approaches exist, they are highly specialized, carry significant risks, and are not appropriate for everyone.

Common questions in this guide

How much does Asherman syndrome treatment raise the risk of placenta accreta?
Studies suggest that pregnancies after treatment for Asherman syndrome have a higher risk of placenta accreta spectrum. One review found PAS in about 10.1% of pregnancies, while one clinic reported a rate of 23.7%; these are group estimates and cannot predict your personal risk.
Does having Asherman syndrome mean that I definitely have placenta accreta?
No. A history of Asherman syndrome increases the risk but does not confirm that placenta accreta spectrum is present. Your individual risk depends on factors such as prior uterine surgery, placenta location, and pregnancy imaging findings.
How do doctors check for placenta accreta after Asherman treatment?
A maternal-fetal medicine team may use detailed abdominal and transvaginal ultrasounds to assess the placenta and uterine wall. MRI may be considered when ultrasound findings are unclear or the placenta is difficult to evaluate, but it is not required for everyone. A reassuring ultrasound lowers concern but cannot completely rule out PAS.
What happens if placenta accreta is suspected during pregnancy?
Your team may plan delivery at a specialized hospital with experts, a neonatal intensive care unit, and blood-transfusion capabilities. A planned Cesarean delivery is often scheduled before the due date, commonly between 34 and 36 weeks for stable patients, although timing is individualized. In severe confirmed cases, the placenta is usually left attached and a Cesarean hysterectomy may be performed.
Which symptoms require urgent medical attention?
Placenta accreta spectrum may cause no symptoms during pregnancy, but vaginal bleeding, regular contractions, severe pelvic pain, or fluid leakage require immediate contact with your maternity unit or an emergency evaluation. Significant bleeding can be life-threatening even when earlier ultrasounds appeared normal.
Do prior C-sections or placenta previa increase the risk after Asherman treatment?
Yes. A prior Cesarean section or other uterine surgery can increase the risk of placenta accreta spectrum, as can placenta previa. Having both a prior Cesarean section and placenta previa is a particularly strong risk factor.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Given my specific history of Asherman's and prior uterine surgeries, how would you classify my risk for placenta accreta spectrum?
  2. 2.Is my placenta low-lying or previa, and where is it located in relation to any prior uterine scars I have?
  3. 3.Will my routine ultrasounds be performed by a maternal-fetal medicine specialist or a sonographer experienced in detecting PAS?
  4. 4.If the ultrasound is reassuring, what does my ongoing monitoring plan look like for the rest of my pregnancy?
  5. 5.If placenta accreta is suspected, does this hospital regularly handle these cases, or will I need to transfer my care to a more specialized facility?
  6. 6.What specific symptoms should prompt me to call you or go to the emergency room immediately?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

Related questions

Can a Normal Pelvic Ultrasound Miss Asherman Syndrome?Do I Need a Hysteroscopic Specialist for Asherman Surgery?Do You Need Asherman Syndrome Treatment Without Pregnancy?How Does Surgery Cause Scar Tissue in Asherman Syndrome?Severe Asherman Syndrome: Pregnancy or Surrogacy Options?Why Does Asherman Syndrome Cause Pain Without a Period?Normal D&C Recovery or Asherman Syndrome Symptoms?What Is the Emotional Impact of Asherman Syndrome?Why Are Uterine Balloon Stents Used After Asherman Surgery?Why Is Estrogen Prescribed After Asherman Syndrome Surgery?

References

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This page is for informational purposes only and does not constitute medical advice. Discuss your individual placenta accreta risk, monitoring, and delivery plan with your obstetric or maternal-fetal medicine team.

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