Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Japan.
Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Japan.
J Gynecol Obstet Hum Reprod. 2021 Sep;50(7):102114. doi: 10.1016/j.jogoh.2021.102114. Epub 2021 Mar 20.
Although various perinatal complications have been reported to be increased in the pregnant patients with adenomyosis, it is not clear what type of patients with adenomyosis is more likely to cause obstetric complications. In this study, we focused on the positional relationship between the placenta and adenomyosis lesion in evaluating perinatal prognosis of pregnant patients with adenomyosis.
This retrospective cohort study was carried out between 1 January 2005 and 31 December 2019 in a single institution. Adenomyosis was diagnosed by magnetic resonance imaging (MRI) and/or transvaginal ultrasonography (TVUS). To evaluate the influence of adenomyosis on perinatal outcomes, we classified the positional relationship between the placenta and the adenomyosis lesion into two groups and examined the perinatal prognosis of the patients with adenomyosis by analyzing their clinical records. Group I (n = 9) was defined when the placenta was not overlaid on adenomyosis lesion. Group II (n = 11) was defined when a part of the placenta was overlaid on adenomyosis lesion.
Twenty pregnant patients with adenomyosis were analyzed. There were no differences in clinical backgrounds between group I and group II. There was a significant increase in the obstetric morbidity in group II than that of Group I(group I: 6.3%, 4/63 vs group II: 18.6%, 26/77; P < 0.001). In group II, fetal growth restriction (FGR) was more frequent (0%, 0/9 vs 45.5%, 5/11; P = 0.042) and the birth weight was significantly lower than that in group I (2951.1 g ± 326.5 g vs 2318.9 ± 656.1 g; P = 0.037). There was a trend of lighter weight of the placenta in group II (550.6 ± 66.5 g vs 437.5 ± 117.8 g; P = 0.063) and the volume of bleeding during delivery was a higher trend in group II than that in group I (845.1 ± 367.1 g vs 1356 ± 604.8 g; P = 0.083). Group II was furtherly subdivided into group IIa (less than half the major axis of the placenta overlaid on adenomyosis lesion) and group IIb (more than half the major axis of placenta overlaid on adenomyosis lesion). The obstetric morbidity tended to be higher in group IIb than in group IIa (group IIa: 22.9%, 8/35 vs group IIb: 42.9%, 18/42); P = 0.09). In group IIb, the frequency of FGR was significantly higher (group IIa: 0%, 0/5 vs IIb: 83.3%, 5/6; P = 0.020) and the birth weight was significantly lower than those in group IIa (2656.8 ± 231.9 g vs 2037 ± 780.1 g; P = 0.040). All cases of FGR, hypertensive disorder of pregnancy (HDP), and oligohydramnios were observed in group IIb.
Placental localization near adenomyosis may increase the risk of perinatal complications.
尽管已有研究报道多种围产期并发症在患有子宫腺肌病的孕妇中增加，但哪种类型的子宫腺肌病患者更有可能引起产科并发症尚不清楚。在这项研究中，我们专注于胎盘和腺肌病病变之间的位置关系，以评估患有子宫腺肌病的孕妇的围产期预后。
这是一项在单家医疗机构进行的回顾性队列研究，时间范围为 2005 年 1 月 1 日至 2019 年 12 月 31 日。通过磁共振成像（MRI）和/或经阴道超声（TVUS）诊断为子宫腺肌病。为了评估子宫腺肌病对围产期结局的影响，我们将胎盘和腺肌病病变之间的位置关系分为两组，并通过分析患者的临床记录来检查患有子宫腺肌病患者的围产期预后。组 I（n=9）定义为胎盘未覆盖在腺肌病病变上。组 II（n=11）定义为部分胎盘覆盖在腺肌病病变上。
分析了 20 例患有子宫腺肌病的孕妇。组 I 和组 II 之间的临床背景没有差异。组 II 的产科发病率明显高于组 I（组 I：6.3%，4/63 例 vs 组 II：18.6%，26/77 例；P<0.001）。在组 II 中，胎儿生长受限（FGR）更为常见（0%，0/9 例 vs 45.5%，5/11 例；P=0.042），出生体重明显低于组 I（2951.1±326.5 g vs 2318.9±656.1 g；P=0.037）。组 II 中胎盘重量较轻（550.6±66.5 g vs 437.5±117.8 g；P=0.063），分娩时出血量呈上升趋势，组 II 高于组 I（845.1±367.1 g vs 1356±604.8 g；P=0.083）。组 II 进一步细分为组 IIa（胎盘的长轴小于一半覆盖在腺肌病病变上）和组 IIb（胎盘的长轴超过一半覆盖在腺肌病病变上）。组 IIb 的产科发病率高于组 IIa（组 IIa：22.9%，8/35 例 vs 组 IIb：42.9%，18/42 例；P=0.09）。在组 IIb 中，FGR 的频率明显更高（组 IIa：0%，0/5 例 vs IIb：83.3%，5/6 例；P=0.020），出生体重明显低于组 IIa（2656.8±231.9 g vs 2037±780.1 g；P=0.040）。组 IIb 中所有 FGR、妊娠高血压疾病（HDP）和羊水过少的病例。
胎盘靠近腺肌病的定位可能会增加围产期并发症的风险。
