Clinical features and perinatal outcomes in women with adenomyosis

To analyze the correlation between Clinical Features and Perinatal Outcomes in the population of pregnancies with adenomyosis.

This retrospective study analyzed 413 pregnant women with ultrasonography/MRI-confirmed adenomyosis (diagnosed pre-pregnancy/early pregnancy) who delivered or miscarried at Peking University Third Hospital (2022-2024). Clinical features (dysmenorrhea, metrorrhagia, uterine volume, concurrent endometriosis) were evaluated for associations with delivery mode, gestational age, postpartum blood loss, premature rupture of membranes (PROM), operation time of cesarean section, placenta accreta, placenta previa, gestational hypertension.

Multivariate analysis demonstrated that women with adenomyosis had significantly higher risks of infertility (OR = 3.540, 95 %CI [2.539-4.937], P < 0.001), pregnancy after assisted reproductive technology(ART) (OR = 2.739, 95 %CI [1.971-3.807], P < 0.001), preterm birth (OR = 2.132, 95 %CI [1.338-3.398], P < 0.001), placenta accreta (OR = 2.433, 95 %CI [1.289-4.593], P = 0.006), and placenta previa (OR = 3.117, 95 %CI [1.729-5.619], P < 0.001) compared to controls, along with longer postpartum hospitalization (β = 0.443, 95 %CI [0.232-0.655], P < 0.001), excessive postpartum hemorrhage(PPH) (OR = 47.956, 95 %CI [20.756-75.155], P < 0.001), and shorter gestation (β = -4.135, 95 %CI [-5.773--2.497], P < 0.001), while no significant differences were found in low birth weight babies(LBW) (OR = 1.586, 95 %CI [0.914-2.750], P = 0.101) or small for gestational age infant(SGA) (OR = 1.688, 95 %CI [0.942-3.026], P = 0.079). PPH correlated positively with uterine volume (β = 0.166, 95 %CI [0.235-1.550], P = 0.008) and age (β = 0.130, 95 %CI [0.669-19.497], P = 0.036), whereas gestational age showed negative correlation with uterine volume (β = -0.163, 95 %CI [-0.072--0.010], P = 0.009). Larger uterine volume increased LBW risk (OR = 1.010, 95 %CI [1.003-1.017], P = 0.007) but decreased SGA risk (OR = 0.984, 95 %CI [0.977-0.992], P < 0.001). Univariate analysis indicated higher LBW incidence when placenta implanted at adenomyosis lesions (P = 0.039). Diffuse adenomyosis exhibited stronger associations with ART (r = 0.355, 95 %CI [0.263-0.440], P < 0.001), LBW (r = 0.142, 95 %CI [0.041-0.240], P = 0.006), and preterm birth (r = 0.106, 95 %CI [0.004-0.205], P = 0.042), though these were nonsignificant in multivariate analysis, while demonstrating 3.963-fold higher cesarean risk (95 %CI [1.797-8.740], P < 0.001) versus focal adenomyosis.

Adenomyosis is associated with an increased risk of a range of pregnancy complications such as infertility, preterm birth, LBW, SGA, placenta accreta, placenta previa and PPH. Moreover, uterine volume before pregnancy, adenomyosis subtypes, and the relative relationship between the placenta and the lesion also have an impact on perinatal outcome.