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. 2023 Mar;160(3):856-863.
doi: 10.1002/ijgo.14383. Epub 2022 Aug 17.

How adenomyosis changes throughout pregnancy: A retrospective cohort study

Emma Bertucci  1 , Filomena G Sileo  2   3 , Marialaura Diamanti  4 , Carlo Alboni  4 , Fabio Facchinetti  4 , Antonio La Marca  4
Affiliations

How adenomyosis changes throughout pregnancy: A retrospective cohort study

Emma Bertucci et al. Int J Gynaecol Obstet. 2023 Mar.

Abstract

Objective: To study how adenomyosis changes during pregnancy and to possibly correlate these changes to maternal and fetal outcomes.

Methods: Retrospective exploratory cohort study including 254 women with a pre-conceptional/first-trimester scan to document adenomyosis and known obstetric outcome. If visible, adenomyosis signs were documented in each trimester and postpartum. Mann-Whitney U tests or χ2 tests were used for continuous and categorical variables, respectively.

Results: A globular uterus was reported in 79% (n = 52) of women with adenomyosis in the first trimester, in 38% (n = 20) and 2% (n = 1) of women in the second and third trimesters, respectively, and postpartum in 77% (n = 34) of women. Asymmetrical thickening (n = 20, 30%) and cysts (n = 15, 23%) were only visible in 1st trimester. Adenomyosis was associated with miscarriage (odds ratio [OR] 5.9, 95% confidence interval [CI] 2.4-14.9, P < 0.001) also in normal conception only (OR 5.1, 95% CI 1.8-14.2, P = 0.002) or adjusting for maternal age (adjusted OR 5.9, 95% CI 2.3-15.2, P < 0.001). Gestational age at delivery was lower in adenomyosis (P = 0.004); the cesarean section rate was higher than in controls (OR 2.5, 95% CI 1.3-4.8, P = 0.007) also adjusting for age (adjusted OR 2.07, 95% CI 1.06-4.08, P = 0.035).

Conclusions: Signs of adenomyosis were visible but progressively disappeared in pregnancy; adenomyosis was associated with an increased risk of early miscarriage. Prospective studies are needed to confirm our results.

Keywords: adenomyosis; pregnancy; sonography; uterus.

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Conflict of interest statement

All authors have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Presence of adenomyoma (red arrows) at 5 weeks of pregnancy (a), at 20 weeks (b), and postpartum (c)
FIGURE 2
FIGURE 2
Presence of hyperechoic islands (red arrows) at 5 weeks (a) and at 18 weeks (b)
FIGURE 3
FIGURE 3
Presence of globular aspect of the uterus (red arrows) at 12 weeks (a), at 19 weeks (b), and postpartum (c)
FIGURE 4
FIGURE 4
Appearance of the translesional vascularity at 15 weeks
FIGURE 5
FIGURE 5
Presence of both hyperechoic islands (red arrows) and asymmetrical thickness (yellow arrows) in the same patient at 20 weeks (a) and at 30 weeks (b)
FIGURE 6
FIGURE 6
Flow chart of the patients and how they were included in the analysis
See this image and copyright information in PMC

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