Placenta Accreta Spectrum Risk in Endometriosis: A Retrospective Cohort Study with ART Subanalysis

Background/Objectives: This study assessed whether endometriosis is associated with an increased risk of placenta accreta spectrum (PAS) disorders and investigated if assisted reproductive technology (ART) further increases the risk in patients with endometriosis. Methods: This retrospective study used multi-institutional data from the TriNetX database to identify patients who experienced delivery on or before 31 December 2024, with a prior diagnosis of endometriosis and ART therapy, as coded by CPT and ICD-10 codes. The primary outcomes included up to 7-day perinatal results, such as PAS (accreta, increta, percreta), and maternal complications, including peripartum hysterectomy, transfusion, postpartum hemorrhage (PPH), ICU admission, and sepsis. Risk ratios, 95% confidence intervals, and p-values were calculated for endometriosis versus no endometriosis and endometriosis patients with ART versus without ART. Results: Out of 3,487,612 patients identified, 24,341 had a prior diagnosis of endometriosis prior to propensity score matching. Propensity score matching was used to control for age, demographic variables, previous procedures, and comorbidities. Compared to controls, endometriosis was linked to a higher risk of PAS disorders (RR 1.74), including accreta (RR 2.22), increta (RR 2.50), and percreta (RR 1.59). Additional complications included peripartum hysterectomy (RR 1.72), transfusion (RR 1.26), PPH (RR 1.35), ICU admission (RR 1.43), and sepsis (RR 1.56). Patients conceived via ART faced greater risks of PAS disorders (RR 2.00), accreta (RR 2.14), hysterectomy (RR 1.63), transfusion (RR 2.10), and PPH (RR 1.66). Conclusions: This study shows a positive link between endometriosis and the risk of PAS disorders and maternal complications, and the use of ART in patients with endometriosis further increases this risk, emphasizing the importance of comprehensive counseling and a multidisciplinary approach to delivery planning for this high-risk group.