Study Objective Does the grade and location of the intra uterine adhesions in women with Asherman's disease determine the location of the placenta and the presence of abnormal invasive placentation (AIP). Design Observational Study. Setting Asherman Expertise Centre, Spaarne Gasthuis Hospital, an academic affiliated community hospital in The Netherlands. Patients or Participants Women with Asherman's disease. Interventions The patients all underwent successful hysteroscopic adhesiolysis. Pregnancies were monitored. Ultrasound and MRI was used to recognize abnormal invasive placentation (AIP). A control hysteroscopy was performed 3 months after pregnancy. Measurements and Main Results 20 women with AIP during pregnancy after successful adhesiolysis were identified between 2017-2019. They had moderate to severe intra uterine adhesions prior to surgery after a first trimester curettage of a post-partum procedure. They all had an ultrasound at 28weeks of gestational age, to determine the location of the placenta and to prenatal diagnose AIP. There was a relation between the grade and location of the intra uterine adhesions and the presence of AIP. There was also a relation between the location and severity of adhesions and the risk of a retained products of conception (RPOC) diagnosed by a control hysteroscopy 3 months after delivery. Conclusion The location and grade of the intra uterine adhesions plays a pivotal role in developing AIP.