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Tsikouras P, Kritsotaki N, Nikolettos K, Kotanidou S, Oikonomou E, Bothou A, Andreou S, Nalmpanti T, Chalkia K, Spanakis V, Tsikouras N, Chalil M, Machairiotis N, Iatrakis G, Nikolettos N. The Impact of Adenomyosis on Pregnancy. Biomedicines 2024; 12:1925. [PMID: 39200389 PMCID: PMC11351718 DOI: 10.3390/biomedicines12081925] [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: 07/16/2024] [Revised: 07/27/2024] [Accepted: 08/20/2024] [Indexed: 09/02/2024] Open
Abstract
Adenomyosis is characterized by ectopic proliferation of endometrial tissue within the myometrium. Histologically, this condition is marked by the presence of islands of benign endometrial glands surrounded by stromal cells. The myometrium appears thinner, and cross-sectional analysis often reveals signs of recent or chronic hemorrhage. The ectopic endometrial tissue may respond to ovarian hormonal stimulation, exhibiting proliferative or secretory changes during the menstrual cycle, potentially leading to bleeding, uterine swelling, and pain. Adenomyosis can appear as either a diffuse or focal condition. It is crucial to understand that adenomyosis involves the infiltration of the endometrium into the myometrium, rather than its displacement. The surgical management of adenomyosis is contingent upon its anatomical extent. The high incidence of the disease and the myths that develop around it increase the need to study its characteristics and its association with pregnancy and potential obstetric complications. These complications often require quick decisions, appropriate diagnosis, and proper counseling. Therefore, knowing the possible risks associated with adenomyosis is key to decision making. Pregnancy has a positive effect on adenomyosis and its painful symptoms. This improvement is not only due to the inhibition of ovulation, which inhibits the bleeding of adenomyotic tissue, but also to the metabolic, hormonal, immunological, and angiogenic changes associated with pregnancy. Adenomyosis affects pregnancy through disturbances of the endocrine system and the body's immune response at both local and systemic levels. It leads to bleeding from the adenomyotic tissue, molecular and functional abnormalities of the ectopic endometrium, abnormal placentation, and destruction of the adenomyotic tissue due to changes in the hormonal environment that characterizes pregnancy. Some of the obstetric complications that occur in women with adenomyosis in pregnancy include miscarriage, preterm delivery, placenta previa, low birth weight for gestational age, obstetric hemorrhage, and the need for cesarean section. These complications are an understudied field and remain unknown to the majority of obstetricians. These pathological conditions pose challenges to both the typical progression of pregnancy and the smooth conduct of labor in affected women. Further multicenter studies are imperative to validate the most suitable method for concluding labor following surgical intervention for adenomyosis.
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Affiliation(s)
- Panagiotis Tsikouras
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (N.K.); (K.N.); (S.K.); (E.O.); (S.A.); (T.N.); (K.C.); (V.S.); (N.T.); (M.C.); (N.N.)
| | - Nektaria Kritsotaki
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (N.K.); (K.N.); (S.K.); (E.O.); (S.A.); (T.N.); (K.C.); (V.S.); (N.T.); (M.C.); (N.N.)
| | - Konstantinos Nikolettos
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (N.K.); (K.N.); (S.K.); (E.O.); (S.A.); (T.N.); (K.C.); (V.S.); (N.T.); (M.C.); (N.N.)
| | - Sonia Kotanidou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (N.K.); (K.N.); (S.K.); (E.O.); (S.A.); (T.N.); (K.C.); (V.S.); (N.T.); (M.C.); (N.N.)
| | - Efthymios Oikonomou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (N.K.); (K.N.); (S.K.); (E.O.); (S.A.); (T.N.); (K.C.); (V.S.); (N.T.); (M.C.); (N.N.)
| | - Anastasia Bothou
- Department of Midwifery, School of Health Sciences, University of West Attica (UNIWA), 12243 Athens, Greece; (A.B.); (G.I.)
| | - Sotiris Andreou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (N.K.); (K.N.); (S.K.); (E.O.); (S.A.); (T.N.); (K.C.); (V.S.); (N.T.); (M.C.); (N.N.)
| | - Theopi Nalmpanti
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (N.K.); (K.N.); (S.K.); (E.O.); (S.A.); (T.N.); (K.C.); (V.S.); (N.T.); (M.C.); (N.N.)
| | - Kyriaki Chalkia
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (N.K.); (K.N.); (S.K.); (E.O.); (S.A.); (T.N.); (K.C.); (V.S.); (N.T.); (M.C.); (N.N.)
| | - Vlasios Spanakis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (N.K.); (K.N.); (S.K.); (E.O.); (S.A.); (T.N.); (K.C.); (V.S.); (N.T.); (M.C.); (N.N.)
| | - Nikolaos Tsikouras
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (N.K.); (K.N.); (S.K.); (E.O.); (S.A.); (T.N.); (K.C.); (V.S.); (N.T.); (M.C.); (N.N.)
| | - Melda Chalil
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (N.K.); (K.N.); (S.K.); (E.O.); (S.A.); (T.N.); (K.C.); (V.S.); (N.T.); (M.C.); (N.N.)
| | - Nikolaos Machairiotis
- Third Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Attikon Hospital, Rimini 1, 12462 Athens, Greece;
| | - George Iatrakis
- Department of Midwifery, School of Health Sciences, University of West Attica (UNIWA), 12243 Athens, Greece; (A.B.); (G.I.)
| | - Nikolaos Nikolettos
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (N.K.); (K.N.); (S.K.); (E.O.); (S.A.); (T.N.); (K.C.); (V.S.); (N.T.); (M.C.); (N.N.)
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Bentefouet TL, Thiam I, Senghor F, Kebe CT, Gaye M, Ahouidi MJD, Dial CMM. [Epidemiological and anatomopathological profile of endometriosis in Dakar: retrospective study over a period of 20 years]. Ann Pathol 2024; 44:57-64. [PMID: 37953128 DOI: 10.1016/j.annpat.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Endometriosis is a gynecological pathology defined by the presence and abnormal development of endometrial tissue outside the uterine cavity. Our objective was to draw up an epidemiological profile and to describe the anatomical clinical forms of endometriosis in Dakar. PATIENTS AND METHODS This is a retrospective study of all cases of external and internal endometriosis diagnosed in an anatomy and pathology laboratory in Dakar over a period of twenty (20) years. The study parameters were collected from anonymous data sheets. Data entry and analysis were performed using version 22 of the EPI INFO and SPSS software. RESULTS Our study involved 104 female patients. The mean age was 47.3±10.0. Among the patients with an adenomyosis condition, the mean age was 49.8 years. Patients with an external endometriosis condition had a mean age of 37.6 years. The location of the endometriosis was statistically correlated with the age of patients and with parity. Anatomically and pathologically, the surgical specimen 89.4% (n=93) was the main type of sampling that was found. The uterine body was the main location of the pathology, with 78.9% (n=82), followed by the umbilical location with 9.6% (n=10). Leiomyomas 44.07% (n=26) were the main associated lesions. CONCLUSION Endometriosis is a gynecological pathology that is unfortunately not well known, and which is under diagnosed in Senegal.
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Affiliation(s)
- Tonleu Linda Bentefouet
- Unité de formation et de recherche en sciences de la santé de Thiès. Dixieme-Thiès, Thies, Senegal.
| | - Ibou Thiam
- Université Cheikh Anta Diop de Dakar, 5005 Dakar -Fann, Senegal
| | - Fabrice Senghor
- Université Assane Seck de Ziguinchor, Diabir-Ziguinchor, Senegal
| | | | - Magib Gaye
- Université Cheikh Anta Diop de Dakar, 5005 Dakar -Fann, Senegal
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