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Sayama S, Iriyama T, Hashimoto A, Suzuki K, Ariyoshi Y, Yano E, Toshimitsu M, Ichinose M, Seyama T, Sone K, Kumasawa K, Hirota Y, Osuga Y. Possible risks and benefits of adenomyomectomy on pregnancy outcomes: a retrospective analysis. AJOG GLOBAL REPORTS 2023; 3:100265. [PMID: 37771974 PMCID: PMC10523262 DOI: 10.1016/j.xagr.2023.100265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Adenomyosis is associated with unfavorable perinatal outcomes; however, the effect of an adenomyomectomy on pregnancy outcomes remains unclear. Pregnancy following an adenomyomectomy has been reported to be associated with a high risk for uterine rupture; however, the actual incidence remains unknown. OBJECTIVE This study aimed to evaluate the effect of an adenomyomectomy on pregnancy outcomes by retrospectively comparing the pregnancy outcomes of women who underwent an adenomyomectomy with those of women with adenomyosis. STUDY DESIGN This was a single-center retrospective study in which the pregnancy outcomes of women who underwent an adenomyomectomy and for whom complete resection of the affected tissue under laparotomy was achieved were compared with those of women with adenomyosis. The following pregnancy outcomes were examined: second-trimester miscarriage, preterm prelabor rupture of membranes, preterm delivery, spontaneous preterm delivery, preeclampsia, rate of cesarean delivery, blood loss during cesarean delivery, incidence of placenta accreta spectrum, neonatal body weight, and small for gestational age infants. RESULTS A total of 18 pregnant women who underwent an adenomyomectomy and 105 pregnant women with adenomyosis were included in this study. All women who underwent an adenomyomectomy delivered via cesarean delivery, and among them, 1 had a uterine rupture at 30 weeks of gestation. Although there was no significant difference between pregnant women who underwent an adenomyomectomy and those with adenomyosis in the incidence of second-trimester miscarriage (0% [0/18] vs 7.6% [8/105], respectively; P=.22), preterm delivery (50% [9/18] vs 32% [34/105], respectively; P=.15), and spontaneous preterm delivery (6% [1/18] vs 15% [16/105], respectively; P=.26), a significant decrease in preterm prelabor rupture of membrane (0% [0/18] vs 12% [13/105], respectively; P<.05), preeclampsia (0% [0/18] vs 12% [13/105], respectively; P<.05), and small for gestational infants (0% [0/18] vs 15% [16/105], respectively; P<.05), as well as a significant increase in the incidence of placenta accreta spectrum (50% [9/18] vs 0% [0/105], respectively; P<.01) and blood loss during cesarean delivery (1748 mL vs 1330 mL, respectively; P<.05) were observed. CONCLUSION Uterine rupture following an adenomyomectomy may occur because of the high incidence of placenta accreta spectrum. However, an adenomyomectomy may reduce adverse pregnancy outcomes associated with adenomyosis, such as preterm prelabor rupture of membranes, preeclampsia, and small for gestational age infants. An adenomyomectomy may be a viable option for women among whom the procedure is inevitable before conception.
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Affiliation(s)
- Seisuke Sayama
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takayuki Iriyama
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Ayako Hashimoto
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kensuke Suzuki
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yu Ariyoshi
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Eriko Yano
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Masatake Toshimitsu
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Mari Ichinose
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takahiro Seyama
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kenbun Sone
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Keiichi Kumasawa
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yasushi Hirota
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yutaka Osuga
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Ono Y, Ota H, Fukushi Y, Tagaya H, Okuda Y, Yoshino O, Yamada H, Hirata S, Wada S. Effectiveness of Laparoscopic Adenomyomectomy on Perinatal Outcomes. Gynecol Minim Invasive Ther 2023; 12:211-217. [PMID: 38034106 PMCID: PMC10683966 DOI: 10.4103/gmit.gmit_45_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/29/2022] [Accepted: 08/10/2022] [Indexed: 01/18/2023] Open
Abstract
Objectives The objective of this study was to observe the influence of laparoscopic adenomyomectomy on perinatal outcomes. Materials and Methods The retrospective cohort study included 43 pregnant cases with adenomyosis who did not undergo laparoscopic surgery before pregnancy (nonsurgery group; 26 cases) and did (surgery group; 17 cases). To evaluate the impact of surgery on perinatal outcomes, nine obstetric complications including preterm delivery, hypertensive disorder of pregnancy, placental malposition, oligohydramnios, gestational diabetes mellitus, uterine rupture, abruptio placentae, and postpartum hemorrhage were selected. One obstetric complication was counted as one point (Maximum 9 points for one person). The obstetrical morbidity was compared by adding up the number of relevant events (0-9) between the two groups. Apgar score, umbilical artery pH (UApH), neonatal intensive care unit (NICU) admission, and neonatal death were also examined. Results The surgery group had a significantly lower prevalence of fetal growth restriction compared to the nonsurgery group (nonsurgery vs. surgery; 26.9%, 7/26 vs. 0%, 0/17: P = 0.031). No differences were found in the morbidity of the nine obstetric complications (19.2%, 45/234 vs. 13.7%, 21/153), gestational weeks (mean ± standard deviation, 37.2 ± 2.4 vs. 36.4 ± 3.2), birth weight (2573.6 ± 557.9 vs. 2555.4 ± 680.8 g), Apgar score (1, 5 min; 8.0 ± 0.7 vs. 7.7 ± 1.2, 8.9 ± 0.6 vs. 8.5 ± 1.8), UApH (7.28 ± 0.08 vs. 7.28 ± 0.06), NICU admission (26.9%, 7/26 vs. 41.2%, 7/17), and neonatal death (0%, 0%) between both groups. Conclusion Laparoscopic adenomyomectomy may not increase obstetric complications, although attention must be paid to uterine rupture during pregnancy.
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Affiliation(s)
- Yosuke Ono
- Department of Obstetrics and Gynecology, University of Yamanashi, Chuo, Japan
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Hajime Ota
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Yoshiyuki Fukushi
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Hikaru Tagaya
- Department of Obstetrics and Gynecology, University of Yamanashi, Chuo, Japan
| | - Yasuhiko Okuda
- Department of Obstetrics and Gynecology, University of Yamanashi, Chuo, Japan
| | - Osamu Yoshino
- Department of Obstetrics and Gynecology, University of Yamanashi, Chuo, Japan
| | - Hideto Yamada
- Center for Recurrent Pregnancy Loss, Teine Keijinkai Hospital, Sapporo, Japan
| | - Shuji Hirata
- Department of Obstetrics and Gynecology, University of Yamanashi, Chuo, Japan
| | - Shinichiro Wada
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan
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Harada T, Taniguchi F, Harada T. Increased risk of obstetric complications in patients with adenomyosis: A narrative literature review. Reprod Med Biol 2022; 21:e12473. [PMID: 35821748 PMCID: PMC9260064 DOI: 10.1002/rmb2.12473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/05/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background Reproductive‐age women occasionally face the pathological condition of adenomyosis, which is often concurrent with endometriosis. It is believed that endometriosis and adenomyosis increases the risk of obstetric complications. Although new insights into the mechanism of obstetric complications due to endometriosis are emerging, there is little information on the etiology of adverse pregnancy outcomes in pregnant women with adenomyosis. Methods We performed a literature review focusing on the pathophysiological pathways of obstetric complications in women with adenomyosis using currently available basic and clinical studies. We used the internet search engines PubMed and Google Scholar to search for studies published between January 2000 and June 2021. We carefully read pertinent sections within each document to ensure relevancy. Main findings The prevalence of adverse pregnancy outcomes in women with adenomyosis is increased after adjusting for conceiving by assisted reproductive technology. Thus, adenomyosis emerges as a relevant factor associated with several obstetric complications such as preterm birth, preterm premature rupture of membranes, placental abruption, small for gestational age/fetal growth restriction, and preeclampsia. Conclusion It is plausible that the impact of adenomyosis on pregnancy outcomes is not always the same; rather it is dependent on the degree of uterine involvement and subtypes.
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Affiliation(s)
- Takashi Harada
- Department of Obstetrics and Gynecology Tottori University Faculty of Medicine Yonago Japan
| | - Fuminori Taniguchi
- Department of Obstetrics and Gynecology Tottori University Faculty of Medicine Yonago Japan
| | - Tasuku Harada
- Department of Obstetrics and Gynecology Tottori University Faculty of Medicine Yonago Japan
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Barbanti C, Centini G, Lazzeri L, Habib N, Labanca L, Zupi E, Afors K, Starace AC. Adenomyosis and infertility: the role of the junctional zone. Gynecol Endocrinol 2021; 37:577-583. [PMID: 33587014 DOI: 10.1080/09513590.2021.1878131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Adenomyosis is a benign uterine disorder characterized by the invasion of the endometrium within the myometrium, starting from the junctional zone (JZ), the inner hormone dependent layer of the myometrium that plays an important role in sperm transport, implantation and placentation. The resulting histological abnormalities and functional defects may represent the pathogenic substrate for infertility and pregnancy complications. The objective of this paper is to review the literature to evaluate the correlation between inner myometrium alterations and infertility and to assess the role of JZ in the origin of adverse obstetric outcomes of both spontaneous and in vitro fertilization (IVF) pregnancies. METHODS we searched Pubmed for all original and review articles in the English language from January1962 until December 2019, using the MeSH terms of 'adenomyosis', 'junctional zone', combined with 'infertility', 'obstetrical outcomes', 'spontaneous conception', 'in vitro fertilization' and 'classification'. The review was divided into three sections to assess this pathogenic correlation, evaluating also the importance of classification of the disease. RESULTS AND CONCLUSIONS Absent or incomplete remodeling of the JZ can affect uterine peristalsis, alter vascular plasticity of the spiral arteries and activate inflammatory pathways, all related to adverse obstetric outcomes. Despite these observations, there is still limited evidence whether adenomyosis is a cause of infertility. However, it is reasonable to screen patients for adenomyosis, to consider pregnant women with diffuse adenomyosis at high risk of adverse obstetric outcomes, and to evaluate the importance of a noninvasive validated classification in the management of women with adenomyosis.
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Affiliation(s)
- Chiara Barbanti
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Nassir Habib
- Department of Obstetrics and Gynaecology, Beaujon Hospital-University of Paris, Paris, France
| | - Luca Labanca
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Karolina Afors
- Department of Obstetrics and Gynaecology, Whittington Hospital, London, UK
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Ono Y, Ota H, Takimoto K, Tsuzuki Y, Nakajima A, Yoshino O, Unno N, Fujino T, Fukushi Y, Wada S. Perinatal outcomes associated with the positional relationship between the placenta and the adenomyosis lesion. J Gynecol Obstet Hum Reprod 2021; 50:102114. [PMID: 33757867 DOI: 10.1016/j.jogoh.2021.102114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/03/2021] [Accepted: 03/10/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Although various perinatal complications have been reported to be increased in the pregnant patients with adenomyosis, it is not clear what type of patients with adenomyosis is more likely to cause obstetric complications. In this study, we focused on the positional relationship between the placenta and adenomyosis lesion in evaluating perinatal prognosis of pregnant patients with adenomyosis. MATERIAL AND METHODS This retrospective cohort study was carried out between 1 January 2005 and 31 December 2019 in a single institution. Adenomyosis was diagnosed by magnetic resonance imaging (MRI) and/or transvaginal ultrasonography (TVUS). To evaluate the influence of adenomyosis on perinatal outcomes, we classified the positional relationship between the placenta and the adenomyosis lesion into two groups and examined the perinatal prognosis of the patients with adenomyosis by analyzing their clinical records. Group I (n = 9) was defined when the placenta was not overlaid on adenomyosis lesion. Group II (n = 11) was defined when a part of the placenta was overlaid on adenomyosis lesion. RESULTS Twenty pregnant patients with adenomyosis were analyzed. There were no differences in clinical backgrounds between group I and group II. There was a significant increase in the obstetric morbidity in group II than that of Group I(group I: 6.3%, 4/63 vs group II: 18.6%, 26/77; P < 0.001). In group II, fetal growth restriction (FGR) was more frequent (0%, 0/9 vs 45.5%, 5/11; P = 0.042) and the birth weight was significantly lower than that in group I (2951.1 g ± 326.5 g vs 2318.9 ± 656.1 g; P = 0.037). There was a trend of lighter weight of the placenta in group II (550.6 ± 66.5 g vs 437.5 ± 117.8 g; P = 0.063) and the volume of bleeding during delivery was a higher trend in group II than that in group I (845.1 ± 367.1 g vs 1356 ± 604.8 g; P = 0.083). Group II was furtherly subdivided into group IIa (less than half the major axis of the placenta overlaid on adenomyosis lesion) and group IIb (more than half the major axis of placenta overlaid on adenomyosis lesion). The obstetric morbidity tended to be higher in group IIb than in group IIa (group IIa: 22.9%, 8/35 vs group IIb: 42.9%, 18/42); P = 0.09). In group IIb, the frequency of FGR was significantly higher (group IIa: 0%, 0/5 vs IIb: 83.3%, 5/6; P = 0.020) and the birth weight was significantly lower than those in group IIa (2656.8 ± 231.9 g vs 2037 ± 780.1 g; P = 0.040). All cases of FGR, hypertensive disorder of pregnancy (HDP), and oligohydramnios were observed in group IIb. CONCLUSION Placental localization near adenomyosis may increase the risk of perinatal complications.
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Affiliation(s)
- Yosuke Ono
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Japan.
| | - Hajime Ota
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Japan
| | - Kanako Takimoto
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Japan
| | - Yoko Tsuzuki
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Japan
| | - Ayako Nakajima
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Japan
| | - Osamu Yoshino
- Department of Obstetrics and Gynecology, Kitasato University School Medicine, Japan
| | - Nobuya Unno
- Department of Obstetrics and Gynecology, Kitasato University School Medicine, Japan
| | - Takafumi Fujino
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Japan
| | - Yoshiyuki Fukushi
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Japan
| | - Shinichiro Wada
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Japan.
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Hashimoto A, Iriyama T, Sayama S, Tsuruga T, Kumasawa K, Nagamatsu T, Osuga Y, Fujii T. Impact of endometriosis and adenomyosis on pregnancy outcomes. HYPERTENSION RESEARCH IN PREGNANCY 2019. [DOI: 10.14390/jsshp.hrp2019-015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ayako Hashimoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo
| | - Takayuki Iriyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo
| | - Seisuke Sayama
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo
| | - Tetsushi Tsuruga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo
| | - Keiichi Kumasawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo
| | - Takeshi Nagamatsu
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo
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Harada T, Taniguchi F, Amano H, Kurozawa Y, Ideno Y, Hayashi K, Harada T. Adverse obstetrical outcomes for women with endometriosis and adenomyosis: A large cohort of the Japan Environment and Children's Study. PLoS One 2019; 14:e0220256. [PMID: 31374085 PMCID: PMC6677302 DOI: 10.1371/journal.pone.0220256] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/11/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Because of the increased number of diagnosed cases of endometriosis or adenomyosis resulting in infertility, many women require assisted reproductive technology (ART) to become pregnant. However, incidences of obstetric complications are increased for women who conceive using ART. There has been no prospective cohort study examining the influence of endometriosis and adenomyosis on obstetric outcomes after adjusting for the confounding influence of ART therapy. OBJECTIVE This study evaluated the impact of endometriosis and adenomyosis on the incidence of adverse pregnancy outcomes. STUDY DESIGN Data were obtained from a prospective cohort study, known as the Japan Environment and Children's Study (JECS), of the incidence of obstetric complications for women with endometriosis and adenomyosis. The data of 103,099 pregnancies that resulted in live birth or stillbirth or that were terminated through abortion between February 2011 and July 2014 in Japan were included. RESULTS Women with endometriosis or adenomyosis were at increased risk for complications during pregnancy compared to those without a medical history of endometriosis (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.23 to 1.41) or adenomyosis (OR, 1.72; 95% CI, 1.37 to 2.16). Our analysis showed that the adjusted ORs for obstetric complications of pregnant women who conceived naturally or after infertility treatment that did not involve ART therapy were 1.26 (CI, 1.17 to 1.35) for pregnant women with a history of endometriosis and 1.52 (CI, 1.19 to 1.94) for those with a history of adenomyosis. CONCLUSIONS The presence of endometriosis and adenomyosis significantly increased the prevalence of obstetric complications after adjusting for the influence of ART outcomes.
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Affiliation(s)
- Takashi Harada
- Department of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Fuminori Taniguchi
- Department of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Hiroki Amano
- Department of Public Health, Tottori University Faculty of Medicine, Yonago, Japan
| | - Youichi Kurozawa
- Department of Public Health, Tottori University Faculty of Medicine, Yonago, Japan
| | - Yuki Ideno
- Department of Laboratory Science and Environmental Health Sciences, Graduate School of Health Sciences, Gunma University, Maebashi, Japan
| | - Kunihiko Hayashi
- Department of Laboratory Science and Environmental Health Sciences, Graduate School of Health Sciences, Gunma University, Maebashi, Japan
| | - Tasuku Harada
- Department of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Japan
- * E-mail:
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Razavi M, Maleki-Hajiagha A, Sepidarkish M, Rouholamin S, Almasi-Hashiani A, Rezaeinejad M. Systematic review and meta-analysis of adverse pregnancy outcomes after uterine adenomyosis. Int J Gynaecol Obstet 2019; 145:149-157. [PMID: 30828808 DOI: 10.1002/ijgo.12799] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 11/05/2018] [Accepted: 03/01/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Studies on the impact of adenomyosis and its pregnancy complications have yielded conflicting results. OBJECTIVE To determine the likelihood of adverse pregnancy outcomes among women with adenomyosis relative to women without adenomyosis. SEARCH STRATEGY PubMed, Embase, Scopus, and Web of Science were searched for studies published up to June 15, 2018. SELECTION CRITERIA Observational studies with medically confirmed pregnancy outcomes as endpoints. DATA COLLECTION AND ANALYSIS Two researchers independently screened and selected relevant studies. Dichotomous data for all adverse pregnancy outcomes were expressed as an odds ratio (OR) with 95% confidence interval (CI), and combined in a meta-analysis by using a random-effects model. MAIN RESULTS Six studies (322 cases and 9420 controls) were eligible for inclusion in the meta-analysis. Women with adenomyosis had an increased likelihood of preterm birth (OR, 3.05; 95% CI, 2.08-4.47; P˂0.001), small for gestational age (OR, 3.22; 95% CI, 1.71-6.08; P˂0.001), and pre-eclampsia (OR, 4.35; 95% CI, 1.07-17.72; P=0.042). CONCLUSION Adenomyosis seems to have a detrimental impact on pregnancy outcomes, resulting in a higher likelihood of preterm birth, small for gestational age, and pre-eclampsia.
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Affiliation(s)
- Maryam Razavi
- Pregnancy Health Research Center, Department of Obstetrics and Gynecology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Arezoo Maleki-Hajiagha
- Research Development Center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sepidarkish
- Department of Biostatistics and Epidemiology, Babol University of Medical Sciences, Babol, Iran
| | - Safoura Rouholamin
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical sciences, Isfahan, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Mahroo Rezaeinejad
- Department of Obstetrics and Gynecology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Cozzolino M, Basile F, Pontrelli G. Effects of adenomyosis on obstetric outcomes. ACTA ACUST UNITED AC 2019; 71:146-154. [DOI: 10.23736/s0026-4784.18.04318-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Yamaguchi A, Kyozuka H, Fujimori K, Hosoya M, Yasumura S, Yokoyama T, Sato A, Hashimoto K. Risk of preterm birth, low birthweight and small-for-gestational-age infants in pregnancies with adenomyosis: A cohort study of the Japan Environment and Children's Study. Acta Obstet Gynecol Scand 2018; 98:359-364. [DOI: 10.1111/aogs.13498] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/20/2018] [Indexed: 01/21/2023]
Affiliation(s)
- Akiko Yamaguchi
- Department of Obstetrics and Gynecology; School of Medicine; Fukushima Medical University; Fukushima Japan
| | - Hyo Kyozuka
- Department of Obstetrics and Gynecology; School of Medicine; Fukushima Medical University; Fukushima Japan
- Fukushima Regional Center for the Japan Environmental and Children's Study; Fukushima Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology; School of Medicine; Fukushima Medical University; Fukushima Japan
- Fukushima Regional Center for the Japan Environmental and Children's Study; Fukushima Japan
| | - Mitsuaki Hosoya
- Fukushima Regional Center for the Japan Environmental and Children's Study; Fukushima Japan
- Department of Pediatrics; School of Medicine; Fukushima Medical University; Fukushima Japan
| | - Seiji Yasumura
- Fukushima Regional Center for the Japan Environmental and Children's Study; Fukushima Japan
- Department of Public Health; School of Medicine; Fukushima Medical University; Fukushima Japan
| | - Tadahiko Yokoyama
- Fukushima Regional Center for the Japan Environmental and Children's Study; Fukushima Japan
| | - Akiko Sato
- Fukushima Regional Center for the Japan Environmental and Children's Study; Fukushima Japan
| | - Koichi Hashimoto
- Fukushima Regional Center for the Japan Environmental and Children's Study; Fukushima Japan
- Department of Pediatrics; School of Medicine; Fukushima Medical University; Fukushima Japan
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Scala C, Leone Roberti Maggiore U, Racca A, Barra F, Vellone VG, Venturini PL, Ferrero S. Influence of adenomyosis on pregnancy and perinatal outcomes in women with endometriosis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:666-671. [PMID: 29266553 DOI: 10.1002/uog.18989] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/14/2017] [Accepted: 11/17/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Several studies have investigated the correlation between endometriosis and adverse pregnancy and perinatal outcomes. However, the role of adenomyosis as a risk factor for adverse perinatal outcome in women with endometriosis has yet to be established. The aim of this study was to explore if fetal and maternal outcomes, in particular the incidence of a small-for-gestational-age (SGA) infant, are different in pregnant women with endometriosis only from in those with the concomitant presence of diffuse or focal adenomyosis. METHODS This was a retrospective analysis of data collected prospectively during a 3-year period. We included 206 pregnant women with endometriosis: 148 (71.8%) with endometriosis only, 38 (18.4%) with focal adenomyosis and 20 (9.7%) with diffuse adenomyosis. Adenomyosis was diagnosed using ultrasonography and was classified as focal or diffuse. The study included patients who conceived spontaneously or by an assisted reproductive technique. Demographics, ultrasound variables and outcome were compared between women with endometriosis only and those with diffuse and those with focal adenomyosis. Logistic regression analysis was performed to assess the association of variables with SGA at birth in women with diffuse and those with focal adenomyosis. RESULTS The three groups were similar in demographic characteristics (age, body mass index, mode of conception). Patients with diffuse adenomyosis compared with those with endometriosis only had significantly lower pregnancy-associated plasma protein A (0.61 vs 0.88 multiple of the median, P < 0.001), higher mean uterine artery pulsatility index in the first (2.23 vs 1.67, P < 0.001) and second (1.30 vs 0.94, P < 0.001) trimesters of pregnancy, and higher incidence of SGA (40% vs 10.8%, P < 0.001). No statistically significant differences were found in patients with focal adenomyosis compared with those with endometriosis only. Logistic regression analysis demonstrated that diffuse adenomyosis (odds ratio = 3.744; 95% CI, 1.158-12.099; P = 0.027) was the only independent risk factor for SGA. CONCLUSIONS The presence of diffuse adenomyosis in pregnant women with endometriosis is strongly associated with delivery of a SGA infant. Women with diffuse adenomyosis should be treated as being at high risk of placental dysfunction, and these pregnancies might therefore need closer monitoring. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C Scala
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
- Piazza della Vittoria 14 S.r.l., Genova, Italy
| | - U Leone Roberti Maggiore
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
- Piazza della Vittoria 14 S.r.l., Genova, Italy
| | - A Racca
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
- Academic Unit of Obstetrics and Gynaecology, Ospedale Policlinico San Martino, Genova, Italy
| | - F Barra
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
- Piazza della Vittoria 14 S.r.l., Genova, Italy
| | - V G Vellone
- Department of Surgical and Diagnostic Sciences, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - P L Venturini
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
- Piazza della Vittoria 14 S.r.l., Genova, Italy
| | - S Ferrero
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
- Piazza della Vittoria 14 S.r.l., Genova, Italy
- Academic Unit of Obstetrics and Gynaecology, Ospedale Policlinico San Martino, Genova, Italy
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Tamura H, Kishi H, Kitade M, Asai-Sato M, Tanaka A, Murakami T, Minegishi T, Sugino N. Complications and outcomes of pregnant women with adenomyosis in Japan. Reprod Med Biol 2017; 16:330-336. [PMID: 29259486 PMCID: PMC5715891 DOI: 10.1002/rmb2.12050] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 07/09/2017] [Indexed: 11/09/2022] Open
Abstract
Purpose To investigate the impact of adenomyosis on the complications and outcomes of pregnancy in Japan. Methods We carried out a multicenter retrospective questionnaire survey. A questionnaire regarding pregnancy complications and the outcomes of pregnancy was sent to 725 facilities. Results Data were obtained on the cases of 272 pregnant women with adenomyosis from 65 facilities. The complications of pregnancy included miscarriage before 12 weeks of pregnancy (14.8%), miscarriage after 12 weeks of pregnancy (9.9%), preterm delivery (24.4%), fetal growth restriction (11.8%), pregnancy‐induced hypertension (9.9%), intrauterine infection (7.3%), and cervical incompetency (5.3%). The rates of pregnancy complications in the three groups classified according to pretreatment for adenomyosis (no pretreatment, medication, surgery) did not differ to a statistically significant extent. The rates of miscarriage (>12 weeks) and cervical incompetency increased according to the size of the adenomyosis. The rates of pregnancy‐induced hypertension and uterine infection in patients with diffuse‐type adenomyosis were higher than that in patients with focal‐type adenomyosis. Conclusions Our results show that the increased size and diffuse type of adenomyosis are associated with adverse pregnancy outcome. We should be aware of the higher incidence of pregnancy‐induced hypertension and uterine infection in patients with diffuse‐type adenomyosis.
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Affiliation(s)
- Hiroshi Tamura
- Department of Obstetrics and Gynecology Yamaguchi University Graduate School of Medicine Ube Japan
| | - Hiroshi Kishi
- Department of Obstetrics and Gynecology Gunma University Graduate School of Medicine Maebashi Japan
| | - Mari Kitade
- Department of Obstetrics and Gynecology Juntendo University School of Medicine Tokyo Japan
| | - Mikiko Asai-Sato
- Department of Obstetrics and Gynecology Yokohama City University Hospital Yokohama Japan
| | - Atsushi Tanaka
- Saint Mother Obstetrics and Gynecology Clinic Institute for ART Fukuoka Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology Shiga University of Medical Science Otsu Japan
| | - Takashi Minegishi
- Department of Obstetrics and Gynecology Gunma University Graduate School of Medicine Maebashi Japan
| | - Norihiro Sugino
- Department of Obstetrics and Gynecology Yamaguchi University Graduate School of Medicine Ube Japan
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Hasdemir PS, Farasat M, Aydin C, Ozyurt BC, Guvenal T, Pekindil G. The Role of Adenomyosis in the Pathogenesis of Preeclampsia. Geburtshilfe Frauenheilkd 2016; 76:882-887. [PMID: 27582582 DOI: 10.1055/s-0042-107080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Adenomyosis can cause defective deep placentation. Preeclampsia is known to be associated with abnormal placentation. The aim of this study was to compare the presence of adenomyosis on magnetic resonance imaging in patients with and without history of preeclampsia in order to investigate the possible role of adenomyosis in the pathogenesis of preeclampsia. MATERIALS AND METHODS This prospective, randomized study consisted of patients with (n = 35) and without (n = 34) history of preeclampsia. Direct (submucosal microcysts, adenomyoma and cystic adenomyoma) and indirect (maximal thickness of junctional zone, ratio of maximal thickness of junctional zone to myometrial thickness, junctional zone differential, focal thickening of junctional zone, globally enlarged uterus and non-uniform junctional zone contours) signs of adenomyosis were assessed by pelvic magnetic resonance imaging. RESULTS The prevalence of adenomyosis was found to be more common in patients with preeclampsia und fetal growth restriction compared to patients without fetal growth restriction (94.4 vs. 64.7 %; p = 0.041), respectively. There was a strong association between maximal thickness of junctional zone (9 vs. 13 mm, p = 0.005), ratio of maximal thickness of junctional zone to myometrial thickness (0.42 vs. 0.66, p = 0.001) and junctional zone differential (3 vs. 5 mm, p = 0.02) and late-onset preeclampsia. CONCLUSIONS Presence of adenomyoma is more common in patients with preeclampsia complicated with fetal growth restriction. Indirect signs of adenomyosis detected on pelvic magnetic resonance imaging might have a role in the pathogenesis of late-onset preeclampsia.
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Affiliation(s)
- P S Hasdemir
- Department of Obstetrics and Gynecology, Celal Bayar University Medical School, Manisa, Turkey
| | - M Farasat
- Department of Radiology, Celal Bayar University Medical School, Manisa, Turkey
| | - C Aydin
- Department of Obstetrics and Gynecology, Celal Bayar University Medical School, Manisa, Turkey
| | - B C Ozyurt
- Department of Public Health, Celal Bayar University Medical School, Manisa, Turkey
| | - T Guvenal
- Department of Obstetrics and Gynecology, Celal Bayar University Medical School, Manisa, Turkey
| | - G Pekindil
- Department of Radiology, Celal Bayar University Medical School, Manisa, Turkey
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14
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Mochimaru A, Aoki S, Oba MS, Kurasawa K, Takahashi T, Hirahara F. Adverse pregnancy outcomes associated with adenomyosis with uterine enlargement. J Obstet Gynaecol Res 2014; 41:529-33. [DOI: 10.1111/jog.12604] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 08/26/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Aya Mochimaru
- Perinatal Center for Maternity and Neonates; Yokohama City University Medical Center; Yokohama Japan
| | - Shigeru Aoki
- Perinatal Center for Maternity and Neonates; Yokohama City University Medical Center; Yokohama Japan
| | - Mari S. Oba
- Department of Biostatistics and Epidemiology; Yokohama City University Graduate School of Medicine and University Medical Center; Yokohama Japan
| | - Kentaro Kurasawa
- Perinatal Center for Maternity and Neonates; Yokohama City University Medical Center; Yokohama Japan
| | - Tsuneo Takahashi
- Perinatal Center for Maternity and Neonates; Yokohama City University Medical Center; Yokohama Japan
| | - Fumiki Hirahara
- Department of Obstetrics and Gynecology; Yokohama City University Hospital; Yokohama Japan
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