Department of Gynecology and Obstetrics, Catharina Hospital, Eindhoven, Eindhoven, The Netherlands; Department of Reproductive Medicine, Ghent University Hospital, Ghent, Belgium; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
Department of Gynecology and Obstetrics, Catharina Hospital, Eindhoven, Eindhoven, The Netherlands; Department of Reproductive Medicine, Ghent University Hospital, Ghent, Belgium.
Am J Obstet Gynecol. 2023 Jul;229(1):49.e1-49.e12. doi: 10.1016/j.ajog.2022.12.013. Epub 2022 Dec 17.
Adenomyosis is a benign gynecologic condition arising from the uterine junctional zone. Recent studies suggest a relationship between adenomyosis and adverse obstetrical outcomes, but evidence remains conflicting. There is no large-scale study investigating obstetrical outcomes in women with adenomyosis using the gold standard of histopathologic diagnosis.
This study aimed to investigate the prevalence of adverse obstetrical and neonatal outcomes in women with histopathologic adenomyosis and that of the general (Dutch) population.
This retrospective population-based study used 2 Dutch national databases (Perined, the perinatal registry, and the nationwide pathology databank [Pathologisch Anatomisch Landelijk Geautomiseerd Archief], from 1995 to 2018) to compare obstetrical outcomes in women before histopathologic adenomyosis diagnosis to the general Dutch population without registered histopathologic adenomyosis. The adjusted odds ratios (95% confidence interval) were calculated for adverse obstetrical outcomes. The outcomes were adjusted for maternal age, parity, ethnicity, year of registered birth, induction of labor, hypertensive disorders in previous pregnancies, multiple gestation, and low socioeconomic status.
The pregnancy outcomes of 7925 women with histopathologic adenomyosis were compared with that of 4,615,803 women without registered adenomyosis. When adjusted for confounders, women with adenomyosis had adjusted odds ratios of 1.37 (95% confidence interval, 1.25-1.50) for hypertensive disorders, 1.37 (95% confidence interval, 1.25-1.51) for preeclampsia, 1.15 (95% confidence interval, 1.07-1.25) for small-for-gestational-age infants, 1.54 (95% confidence interval, 1.41-1.68) for emergency cesarean delivery, 1.24 (95% confidence interval, 1.12-1.37) for failure to progress, 1.29 (95% confidence interval, 1.10-1.48) for placental retention, and 1.23 (95% confidence interval, 1.10-1.38) for postpartum hemorrhage. No increased risk of HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, placental abruption, or operative vaginal delivery or need for oxytocin stimulation was found.
Women with a histopathologic diagnosis of adenomyosis showed an increased prevalence of hypertensive disorders of pregnancy and small-for-gestational-age infants, failure to progress in labor, and placental retention compared with the general population in previous pregnancies. This suggests that uterine (contractile) function in labor and during pregnancy is impaired in women with adenomyosis.
子宫腺肌病是一种起源于子宫结合区的良性妇科疾病。最近的研究表明，子宫腺肌病与不良产科结局之间存在关联，但证据仍存在争议。目前尚无大规模研究使用组织病理学诊断这一金标准来调查患有子宫腺肌病的女性的产科结局。
本研究旨在调查组织病理学诊断为子宫腺肌病的女性与一般（荷兰）人群的不良产科和新生儿结局的患病率。
本回顾性基于人群的研究使用了 2 个荷兰国家数据库（Perined，围产期登记处和全国病理数据库[Pathologisch Anatomisch Landelijk Geautomiseerd Archief]，从 1995 年至 2018 年），比较了组织病理学诊断为子宫腺肌病前的女性与未登记组织病理学诊断为子宫腺肌病的一般荷兰人群的产科结局。计算了不良产科结局的调整优势比（95%置信区间）。将结局调整为产妇年龄、产次、种族、登记分娩年份、引产、既往妊娠高血压疾病、多胎妊娠和低社会经济地位。
将 7925 名组织病理学诊断为子宫腺肌病的女性的妊娠结局与 4615803 名未登记为子宫腺肌病的女性进行了比较。在调整混杂因素后，患有子宫腺肌病的女性发生高血压疾病的调整优势比为 1.37（95%置信区间，1.25-1.50），子痫前期为 1.37（95%置信区间，1.25-1.51），胎儿小于胎龄为 1.15（95%置信区间，1.07-1.25），急诊剖宫产为 1.54（95%置信区间，1.41-1.68），产程进展不良为 1.24（95%置信区间，1.12-1.37），胎盘滞留为 1.29（95%置信区间，1.10-1.48），产后出血为 1.23（95%置信区间，1.10-1.38）。未发现 HELLP（溶血、肝酶升高和血小板计数降低）综合征、胎盘早剥、阴道分娩或需要催产素刺激的风险增加。
与前次妊娠的一般人群相比，组织病理学诊断为子宫腺肌病的女性患妊娠高血压疾病和胎儿小于胎龄、产程进展不良和胎盘滞留的患病率增加。这表明子宫腺肌病患者的子宫（收缩）功能在分娩和妊娠期间受损。
