Possible risks and benefits of adenomyomectomy on pregnancy outcomes: a retrospective analysis
Seisuke Sayama, Takayuki Iriyama, Ayako Hashimoto, Kensuke Suzuki, Yu Ariyoshi, Eriko Yano, Masatake Toshimitsu, Mari Ichinose, Takahiro Seyama, Kenbun Sone, Keiichi Kumasawa, Yasushi Hirota, Yutaka Osuga
Abstract
Adenomyosis is associated with unfavorable perinatal outcomes; however, the effect of adenomyomectomy on pregnancy outcomes remains unclear. Pregnancy following adenomyomectomy has been reported to be associated with a high risk of uterine rupture; however, the actual incidence remains unknown. This study aimed to evaluate the effect of adenomyomectomy on pregnancy outcomes by retrospectively comparing the pregnancy outcomes of women who underwent adenomyomectomy with those of women with adenomyosis. This was a single-center retrospective study comparing the pregnancy outcomes of women who underwent adenomyomectomy and achieved complete resection of the disease under laparotomy and women with adenomyosis. The following pregnancy outcomes were examined: second-trimester miscarriage, preterm prelabor rupture of membranes, preterm delivery, spontaneous preterm delivery, preeclampsia, rate of caesarean section, blood loss during caesarean section, incidence of placenta accreta spectrum, neonatal body weight, and small for gestational age infants. Eighteen pregnant women who underwent adenomyomectomy and 105 pregnant women with adenomyosis were included in this study. All women who underwent adenomyomectomy delivered via caesarean section, wherein one had uterine rupture at 30 weeks of gestation. Although there was no significant difference between pregnant women who underwent adenomyomectomy and pregnant women with adenomyosis in the incidence of second trimester miscarriage (0% [0/18] vs. 7.6% [8/105], respectively, p=0.22), preterm delivery (50% [9/18] vs. 32% [34/105], respectively, p=0.15), and spontaneous preterm delivery (6% [1/18] vs. 15% [16/105], respectively, p=0.26), significant decrease in preterm prelabor rupture of membrane (0% [0/18] vs. 12% [13/105], respectively, p<0.05), preeclampsia (0% [0/18] vs. 12% [13/105], respectively, p<0.05), and small for gestational infants (0% [0/18] vs. 15% [16/105], respectively, p<0.05), as well as significant increase in the incidence of placenta accreta spectrum (50% [9/18] vs. 0% [0/105], respectively, p<0.01) and blood loss during caesarean section (1748 ml vs. 1330 ml, respectively, p<0.05) were observed. Uterine rupture following adenomyomectomy may occur because of the high incidence of placenta accreta spectrum. However, adenomyomectomy may reduce adverse pregnancy outcomes associated with adenomyosis, such as preterm prelabor rupture of membranes, preeclampsia, and small for gestational age infants. Adenomyomectomy may be a viable option for women in whom the procedure is inevitable prior to conception.