Shinohara Satoshi, Okuda Yasuhiko, Hirata Shuji, Suzuki Kohta
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi.
Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine.
Tohoku J Exp Med. 2020 Jul;251(3):231-239. doi: 10.1620/tjem.251.231.
As the number of women who postpone their first pregnancy until their late 30s or early 40s is increasing, adenomyosis is more frequently encountered by obstetricians. Some studies have reported on the relationship between adenomyosis and pregnancy complications. We aimed to investigate the effect of adenomyosis on pregnancy complications and outcomes and associations between adenomyosis type and pregnancy outcomes. This multicenter retrospective 1:4 case-control study included 61 women with singleton pregnancies diagnosed with adenomyosis. The control group included women with singleton pregnancies without adenomyosis; these women were matched to those with adenomyosis using propensity scores. The incidence of obstetric complications, delivery, and neonatal outcomes were compared. The adenomyosis group (n = 61) had significantly higher incidence of preterm delivery (21.3% vs. 9.4%), hypertensive disorders of pregnancy (13.1% vs. 5.3%), cesarean delivery (46.0% vs. 20.9%), and postpartum hemorrhage (57.3% vs. 36.8%) than the control group (n = 244). Subgroup analysis by the adenomyosis type revealed that the diffuse adenomyosis group (n = 41) was significantly more likely to experience preterm labor (29.3% vs. 7.3%), hypertensive disorders of pregnancy (17.0% vs. 5.5%), severe hypertensive disorders of pregnancy (12.2% vs. 1.8%), preterm premature rupture of membranes (12.2% vs. 2.4%), cesarean delivery (61.3% vs. 18.9%), and postpartum hemorrhage (70.7% vs. 44.5%) than the control group (n = 164). The focal adenomyosis (n = 20) group was not statistically different from the control group (n = 80) with respect to obstetric complications. Women with diffuse adenomyosis require more careful perinatal management than previously thought.
随着将首次怀孕推迟到30多岁晚期或40岁出头的女性数量不断增加，产科医生更频繁地遇到子宫腺肌病。一些研究报告了子宫腺肌病与妊娠并发症之间的关系。我们旨在研究子宫腺肌病对妊娠并发症和结局的影响以及子宫腺肌病类型与妊娠结局之间的关联。这项多中心回顾性1:4病例对照研究纳入了61例诊断为子宫腺肌病的单胎妊娠女性。对照组包括无子宫腺肌病的单胎妊娠女性；这些女性使用倾向评分与子宫腺肌病患者进行匹配。比较了产科并发症、分娩和新生儿结局的发生率。子宫腺肌病组（n = 61）的早产发生率（21.3%对9.4%）、妊娠高血压疾病发生率（13.1%对5.3%）、剖宫产率（46.0%对20.9%）和产后出血发生率（57.3%对36.8%）均显著高于对照组（n = 244）。按子宫腺肌病类型进行的亚组分析显示，弥漫性子宫腺肌病组（n = 41）发生早产（29.3%对7.3%）、妊娠高血压疾病（17.0%对5.5%）、重度妊娠高血压疾病（12.2%对1.8%）、胎膜早破（12.2%对2.4%）、剖宫产（61.3%对18.9%）和产后出血（70.7%对44.5%）的可能性显著高于对照组（n = 164）。局灶性子宫腺肌病组（n = 20）在产科并发症方面与对照组（n = 80）无统计学差异。弥漫性子宫腺肌病女性需要比以前认为的更仔细的围产期管理。
