Impact of endometriosis and adenomyosis on pregnancy outcomes

Hashimoto, Ayako; Iriyama, Takayuki; Sayama, Seisuke; Tsuruga, Tetsushi; Kumasawa, Keiichi; Nagamatsu, Takeshi; Osuga, Yutaka; Fujii, Tomoyuki

doi:10.14390/jsshp.hrp2019-015

Cited by 9 publications

(6 citation statements)

References 47 publications

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“…What is known is that there are no reports of these changes occurring outside of pregnancy and thus, this phenomenon is likely unique to pregnancy. In addition, markedly enhanced localized uterine inflammation is undoubtedly present and its adverse effects on pregnancy (i.e., its association with obstetrical disorders reported in pregnancies involving adenomyosis 8,9 ) need to be elucidated in future studies. It is intriguing that our case as well as previous case reports all involved complications such as miscarriage, preterm birth, preeclampsia, or nonreassuring fetal status, all of which are reportedly associated with adenomyosis-complicated pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy‐induced hemorrhagic degeneration of adenomyosis

Nakanishi

Iriyama

Sayama

et al. 2022

J of Obstet and Gynaecol

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Uterine fibroids are known to degenerate during pregnancy, but it is unknown if similar pathologic condition occurs in adenomyosis. A 38‐year‐old para 1 woman exhibited uterine tenderness and a markedly elevated inflammatory response at 22 weeks of gestation. Based on magnetic resonance imaging (MRI) findings indicative of hemorrhagic components in an adenomyosis lesion, we judged these features resulted from degeneration of adenomyosis after excluding the possibility of underlying infection by amniocentesis. Although these symptoms improved with conservative management, nonreassuring fetal status prompted an emergency cesarean section at 27 weeks of gestation. MRI performed 4 months postpartum revealed the degeneration had completely disappeared. The present case confirms the presence of a pathologic condition—transient degeneration in adenomyosis—which is triggered by pregnancy.

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Section: Discussionmentioning

confidence: 99%

Pregnancy‐induced hemorrhagic degeneration of adenomyosis

Nakanishi

Iriyama

Sayama

et al. 2022

J of Obstet and Gynaecol

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“…These can also be related to a failure of the physiologic transformation of the spiral arteries in the inner myometrial segment or junctional zone (JZ). Alterations in the JZ in women with EM and AM can further influence the vascular resistance of JZ spiral arteries at the onset of decidualization [ 42 ] and lead to incomplete spiral artery remodelling and a reduction in placental blood flow [ 43 ]. The underlying mechanism is highly complex and currently under debate.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy outcomes in women with infertility and coexisting endometriosis and adenomyosis after laparoscopic surgery: a long-term retrospective follow-up study

Shi

Dai

Zhang

et al. 2021

BMC Pregnancy Childbirth

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Background Adenomyosis (AM) and endometriosis (EM) often coexist. Laparoscopic surgery is one of the main methods for diagnosing and treating these conditions. This study aims to investigate the pregnancy outcomes of women with infertility with both AM and EM after laparoscopic surgery and to identify the relevant associated factors. Methods This is a retrospective study involving women with infertility diagnosed with EM and AM. All patients had undergone laparoscopic surgery and were divided into two groups according to their pregnancy outcomes. Demographic data, operation records, and pregnancy outcomes were collected. Results A total of 226 female patients with infertility diagnosed with both AM and EM underwent laparoscopic surgery. Of these, a total of 176 patients completed follow-up. Ninety-seven patients had live births, including 81 full-term and 16 preterm deliveries. The clinical pregnancy and live birth rates were 67.4 and 55.11%, respectively. One hundred thirty-five patients received in vitro fertilization (IVF), with 70 (51.85%) of these patients having live births. Age, endometrioma size, and uterus size were significantly lower in those who had a successful delivery. There was no statistically significant difference in symptoms, except that those who achieved live birth had a lower rate of anaemia (13.40% vs. 25.32%, p = 0.044). The group that did not proceed to have a live birth had a higher percentage of ovarian and peritoneal endometriosis (p < 0.05), while the distribution of deep infiltrating endometriosis and adenomyosis types were similar. Mean uterus diameter (OR: 0.636, 95% CI: 0.434–0.932, p = 0.020) and endometriosis fertility index (EFI) (OR: 1.299, 95% CI: 1.101–1.531, p = 0.002) were significantly correlated with live birth in the multivariable analysis. Conclusions Endometriosis and adenomyosis appear to have an adverse effect on pregnancy outcome. These might be related to the size of the uterus and EFI. Obstetricians and gynaecologists should be alert to this potential adverse effect and manage these patients accordingly.

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“…These can also be related to failure of the physiologic transformation of spiral arteries in the inner myometrial segment, or junctional zone (JZ). Alterations of the JZ in women with EM and AM can in uence vascular resistance of JZ spiral arteries at the onset of decidualization [25] and lead to incomplete spiral artery remodeling and the reduction of placental blood ow [26]. The mechanism is complex, and the existing results are debatable.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy outcomes of infertile women with co-existing endometriosis and adenomyosis after laparoscopic surgery: a long-term follow-up

Shi

Dai

Zhang

et al. 2020

Preprint

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Background: Adenomyosis and endometriosis are often co-existent. Laparoscopic surgery is one of the main methods to diagnose and treat these conditions. However, very few studies have been done that concentrate on the pregnancy outcomes of infertile women with both adenomyosis and endometriosis after laparoscopic surgery, as well as the relevant influential factors.Methods: This is a retrospective, cross-sectional study including infertile women diagnosed with endometriosis and adenomyosis. All patients had undergone laparoscopic surgery and were divided into two groups according to pregnancy outcomes. Demographic data, operation records, and pregnancy outcomes were collected.Results: Ninety-seven patients had live births, including 81 full-term and 16 preterm deliveries. The biochemical pregnancy, clinical pregnancy, and live birth rates were 80.87%, 67.4, and 55.11% respectively. One hundred thirty-five patients received IVF with 70 (51.85%) patients having live births. Age, size of endometrioma, and size of uterus were significantly lower in those who had a successful delivery. There was no statistical difference in symptoms except anemia (13.40% vs. 25.32%, p=0.044). The group that failed to have a live birth had a higher percentage of ovarian and peritoneal endometriosis (P<.05), while the distribution of deep infiltrating endometriosis and adenomyosis types were similar. Mean uterus diameter (OR: 0.636, 95% CI: 0.434-0.932, p = 0.020) and endometriosis fertility index (EFI) (OR:1.299, 95% CI: 1.101-1.531, p = 0.002) were significantly correlated with live births in the multivariate analysis.Conclusions: Endometriosis and adenomyosis have an adverse effect on fertility. IVF is an important technology improving pregnancy rate even after surgery. The size of the uterus and EFI were independent risk factors for pregnancy outcomes.

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Impact of endometriosis and adenomyosis on pregnancy outcomes

Cited by 9 publications

References 47 publications

Pregnancy‐induced hemorrhagic degeneration of adenomyosis

Pregnancy‐induced hemorrhagic degeneration of adenomyosis

Pregnancy outcomes in women with infertility and coexisting endometriosis and adenomyosis after laparoscopic surgery: a long-term retrospective follow-up study

Pregnancy outcomes of infertile women with co-existing endometriosis and adenomyosis after laparoscopic surgery: a long-term follow-up

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