Table 1: Risk Factors for PAS After Non-Cesarean Uterine Surgery

Impact of Myomectomy on Placenta Accreta Spectrum Risk

Myomectomy, the surgical removal of uterine fibroids, is commonly performed for symptomatic relief in women. However, studies show that myomectomy can significantly increase the risk of PAS in subsequent pregnancies. The mechanism is believed to involve scarring or changes to the uterine lining, which can disrupt normal placental implantation (Yang et al., 2024).

The current literature indicates that the risk of developing PAS after myomectomy is particularly pronounced when the uterine cavity is breached during surgery. A recent analysis reported that the OR for PAS after myomectomy is 2.29, highlighting the need for careful monitoring of women with such surgical histories (Yang et al., 2024).

Role of Hysteroscopic Procedures in PAS Development

Hysteroscopic procedures, including hysteroscopic myomectomy and adhesiolysis, have become increasingly common for managing intrauterine pathologies. Unfortunately, these interventions can also elevate the risk of PAS. A systematic review revealed that hysteroscopic adhesiolysis is associated with an OR of 7.72 for developing PAS, indicating a significant increase in risk compared to those without such surgical history (Yang et al., 2024).

The underlying concern is that hysteroscopic procedures can create an environment conducive to abnormal placental attachment due to the damage inflicted on the uterine lining, leading to insufficient healing and scarring, which can predispose to PAS in later pregnancies.

Significance of Dilatation and Curettage in Subsequent Pregnancies

Dilatation and curettage (D&C) is often performed for diagnostic or therapeutic reasons, including miscarriage management. The procedure can cause injury to the endometrial lining, which may result in scarring and an increased likelihood of PAS in subsequent pregnancies. A meta-analysis found that women with a history of D&C had an OR of 2.28 for developing PAS, reinforcing the need for vigilance in monitoring patients with prior D&C histories (Yang et al., 2024).

Conclusions and Implications for Clinical Practice

In summary, the association between prior non-cesarean uterine surgeries and the increased risk of PAS underscores the necessity for comprehensive prenatal care and risk assessment in women with such surgical histories. The evidence indicates that not only cesarean deliveries but also myomectomy, D&C, and hysteroscopic procedures significantly contribute to PAS risk. Healthcare providers must ensure thorough surgical histories are taken and consider multidisciplinary approaches to manage pregnant women at risk effectively.

Frequently Asked Questions (FAQs)

Q1: What is the placenta accreta spectrum?
A: PAS encompasses a range of conditions where the placenta is abnormally attached to the uterine wall, leading to complications during pregnancy and delivery.

Q2: How does uterine surgery affect the risk of PAS?
A: Uterine surgeries can cause scarring and disruption of the uterine lining, increasing the likelihood of abnormal placentation in subsequent pregnancies.

Q3: Is myomectomy associated with PAS risk?
A: Yes, myomectomy has been associated with an increased risk of PAS, particularly if the uterine cavity is breached during the procedure.

Q4: What role do hysteroscopic procedures play in PAS?
A: Hysteroscopic procedures can significantly increase the risk of PAS due to potential damage inflicted on the uterine lining, leading to scarring.

Q5: What should women with a history of uterine surgery do when planning a pregnancy?
A: Women with a history of uterine surgery should discuss their surgical history with their healthcare provider to assess risks and plan appropriate prenatal care.

References

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