The Impact of Adenomyosis on Pregnancy and Pregnancy Outcomes: A Review

Abstract

ObjectiveThe aim of this review was to describe the risk factors, diagnosis, and effects on pregnancy of the gynecologic condition adenomyosis.MethodsA PubMed, Web of Science, and CINAHL search was undertaken. Citations were limited to the past 30 years.ResultsThere were 223 articles identified, with 31 articles being the basis of this review. Adenomyosis is a relatively common gynecologic condition that was previously thought to predominantly occur in older women, as it was diagnosed most commonly after a hysterectomy. As imaging techniques have advanced, this condition is now able to be diagnosed much earlier in life and is estimated to affect up to 20% of reproductive aged women. As studies have followed these women through subsequent pregnancies, an increased risk of adverse pregnancy outcomes has been observed. These include miscarriage, preterm birth, preterm prelabor rupture of membranes, small for gestational age, low birthweight, and preeclampsia, among others. This review is to examine the incidence, risk factors, and diagnostic criteria of adenomyosis and to then discuss its role in adverse pregnancy outcomes.ConclusionsAdenomyosis has been predominately a gynecologic condition, but now has been shown to adversely affect pregnancy outcomes. Diagnosis is made with histology, but may be suspected based on magnetic resonance imaging and ultrasound findings. Despite evidence of adverse pregnancy outcomes, there are no established strategies to risk, stratify, or prevent any of these outcomes.Target AudienceObstetricians and gynecologists, family medicine physiciansLearning ObjectivesAfter completion of this article, the reader should be better able to interpret the incidence and diagnostic criteria for adenomyosis; identify patients at risk for adenomyosis; and predict the adverse outcomes of pregnancy related to adenomyosis.

Adenomyosis in Pregnancy—Should It Be Managed in High-Risk Obstetric Units?

“…For this reason, some researchers tried to summarize the current evidence on the risks associated with adenomyosis during pregnancy in several literature reviews, such as the ones carried out by Harada et al [ 27 ], Buggio et al [ 28 ], and Wendel et al [ 29 ]. However, these papers just reviewed the literature and speculated about the potential mechanisms that explain why adenomyosis can produce poorer obstetrical outcomes [ 27 ] and highlighted several methodological drawbacks of the studies reported, such as poor design, small sample size, high qualitative heterogeneity, potential misclassification bias, and co-morbid conditions; this prevents drawing definitive conclusions on the strength of the observed associations and on the magnitude of the treatment effects [ 28 ].…”

“…They observed an increased risk for spontaneous abortion (OR: 3.49, 95% CI: 1.41–8.65), pre-eclampsia (OR: 7.87, 95% CI: 1.26–49.20), small for gestational age (OR: 3.90, 95% CI: 2.10–7.25), preterm delivery (OR: 2.74, 95% CI: 1.89–3.97), and cesarean section (OR: 2.62, 95% CI: 1.00–6.89). Nirgianakis et al reported more recently another meta-analysis on seventeen studies comprising 1115 women diagnosed as having adenomyosis and 96,225 controls [ 29 ]. These authors observed an increased risk for spontaneous abortion (OR: 2.50, 95% CI: 1.26–4.95), pre-eclampsia (OR: 4.32, 95% CI: 1.68–11.09), small for gestational age (OR: 2.10, 95% CI: 1.17–3.77), preterm delivery (OR: 2.63, 95% CI: 1.96–3.54), and cesarean section (OR: 4.44, 95% CI: 2.64–7.46).…”

High-intensity focused ultrasound ablation combined with systemic methotrexate treatment of intramural ectopic pregnancy: A case report

“…Pregnancy patients with adenomyosis have a high rate of miscarriage. [ 13 ] Therefore, pregnancy related to adenomyosis is a very difficult problem.…”

Possible risks and benefits of adenomyomectomy on pregnancy outcomes: a retrospective analysis

“…Adenomyosis is also known to be associated with unfavorable pregnancy outcomes, such as an increased incidence of second-trimester miscarriages, preterm prelabor rupture of membrane (pPROM), preterm delivery, preeclampsia, and small for gestational age infants (SGA). 3 , 4 , 5 , 6 , 7 …”

“… 6 , 10 , It is unknown how the removal of the adenomyotic lesion affects pregnancy outcomes, and the only 2 studies that followed pregnancies after an adenomyomectomy and other case reports and case series suggested that these women are at risk for uterine rupture and early miscarriage. 7 , 11 , 12 However, the actual risk for uterine rupture has not been elucidated because of the lack of previous reports and nor has the effects of adenomyomectomy on pregnancy outcomes, such as pPROM, preeclampsia, and SGA, in comparison with women with adenomyosis. To evaluate the effects of an adenomyomectomy on pregnancy outcomes, we retrospectively compared the pregnancy outcomes of women who underwent adenomyomectomy before conception with those of women with adenomyosis.…”