The association between uterine adenomyosis and adverse obstetric outcomes: A propensity score‐matched analysis

Mandelbaum, Rachel S.; Melville, Samuel J F; Violette, Caroline; Guner, Joie; Doody, K.M.; Matsuzaki, Shinya; Quinn, Molly M.; Ouzounian, Joseph G.; Paulson, Richard J.; Matsuo, Koji

doi:10.1111/aogs.14581

Cited by 9 publications

(1 citation statement)

References 42 publications

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“…Interestingly, a nationwide US study showed that adenomyosis is associated with an increased rate of placenta previa. 22 However, this study did not investigate the presence or absence of adenomyosis or uterine fibroids.…”

Section: Discussionmentioning

confidence: 94%

Cervical angle as a possible predictor of abnormal placental position in women with endometriosis

Higeta,

Kitahara,

Tanaka

et al. 2024

J of Obstet and Gynaecol

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BackgroundWe aimed to examine the effects of endometriosis on the rate of abnormal placentation by comparing the data of pregnant women with and without endometriosis.MethodsA case–control study was conducted to compare the perinatal outcomes between women with and without endometriosis. In the subgroup analysis, magnetic resonance imaging (MRI) scans of pregnant women with placenta previa were used to measure the cervical angle and its relationship with endometriosis. The cervical angle was measured as the angle between the cervical glands and the line perpendicular to the spinal column in each sagittal MRI section.ResultsWe retrospectively analyzed data from 3453 cases of singleton deliveries between 2015 and 2019 at two study facilities. Among them, 159 had clinically or surgically confirmed endometriosis. The odds ratio (OR) for abnormal placental position was significantly higher in pregnant women with endometriosis (OR. 2.82; 95% confidence interval [CI], 1.58–5.04). The OR was 3.21 (95% CI, 1.57–6.55) in the endometriosis‐surgery group (91 patients) and 2.32 (95% CI, 0.91–5.88) in the non‐surgery group (68 patients). Furthermore, 44 women who underwent pelvic MRI after 30 weeks of gestation were included to examine the cervical angle. Then, we compared the date of pregnant women with (n = 6) and without endometriosis (n = 38). Regardless of placental attachment position, the cervical angle was significantly lower in the group with than in the group without a history of endometriosis.ConclusionPregnant women with a history of endometriosis may have stronger uterine retroversion, which could potentially contribute to abnormal placental positioning.

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Section: Discussionmentioning

confidence: 94%

Cervical angle as a possible predictor of abnormal placental position in women with endometriosis

Higeta,

Kitahara,

Tanaka

et al. 2024

J of Obstet and Gynaecol

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Risk factors for placenta accreta spectrum without prior cesarean section: A case–control study in China

You,

Wang,

Han

et al. 2024

Intl J Gynecology & Obste

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ObjectiveTo identify the risk factors for placenta accreta spectrum (PAS) disorders in women without prior cesarean section (CS).MethodsThis retrospective case–control study investigated patients without prior CS who gave birth at Peking University Third Hospital between January 1, 2015 and December 31, 2021. Patients diagnosed with PAS according to the clinical diagnostic criteria of the 2019 International Federation of Gynecology and Obstetrics (FIGO) classification were included as the study group. Patients were matched as the control group according to delivery date and placenta previa, in a 1:2 allocation ratio. Maternal characteristics were compared between the two groups.ResultsThe study included 348 patients in the study group and 696 in the control group. The multivariate analysis showed that the independent risk factors of PAS consisted of operative hysteroscopy (once: adjusted odds ratio [aOR] 2.38, 95% CI 1.28–4.24, P = 0.006; twice or more: aOR 5.43, 95% CI 1.04–28.32, P = 0.045), uterine curettage (once: aOR 2.54, 95% CI 1.80–3.58, P < 0.001; twice: aOR 3.01, 95% CI 1.81–5.02, P < 0.001; three or more times: aOR 9.18, 95% CI 4.64–18.18, P < 0.001), multifetal pregnancy (aOR 5.64, 95% CI 3.01–10.57, P < 0.001), adenomyosis (aOR 2.77, 95% CI 1.23–6.22, P = 0.014), in vitro fertilization (aOR 1.51, 95% CI 1.04–2.20, P = 0.030) and pre‐eclampsia (aOR 2.72, 95% CI 1.36–5.45, P = 0.005), and the independent protective factor was being multiparous (aOR 0.37, 95% CI 0.25–0.54, P < 0.001).ConclusionAfter controlling the effect of placenta previa, we found that patients with PAS without prior CS had unique maternal characteristics. Classification and quantification of the intrauterine surgeries they have undergone is essential for identifying high‐risk patients. Early identification of high‐risk groups by risk factors has the potential to improve the prognosis considerably.

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Association between adenomyosis and placenta accreta and mediation effect of assisted reproductive technology on the association: A nationwide observational study

Wada,

Takahashi,

Ogoyama

et al. 2024

Intl J Gynecology & Obste

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ObjectivesTo investigate the association between adenomyosis and placenta accreta spectrum (PAS) and to evaluate the effect of assisted reproductive technology (ART) in mediating this association.MethodsWe retrieved data for singleton women from the Japanese nationwide perinatal registry between 2013 and 2019, excluding women with a history of adenomyomectomy. To investigate the association between adenomyosis and PAS among women, we used a multivariable logistic regression model with multiple imputation for missing data. We evaluated mediation effect of ART including in vitro fertilization and intracytoplasmic sperm injection on the association between adenomyosis and PAS using causal mediation analysis based on the counterfactual approach.ResultsOf 1 500 173 pregnant women, 1539 (0.10%) had adenomyosis. The number receiving ART was 489/1539 (31.8%) and 117 482/1 498 634 (7.8%) in women with and without adenomyosis, respectively. The proportion of women who developed PAS was 21/1539 (1.4%) in women with adenomyosis and 7530/1 498 634 (0.5%) in women without adenomyosis. Adenomyosis was significantly associated with PAS (odds ratio [OR] 1.95; 95% confidence interval [CI] 1.26–3.00; P = 0.002). Mediation analysis showed that OR of the total effect of adenomyosis on PAS was 1.98 (95% CI 1.13–3.04), OR of natural indirect effect (effect explained by ART) was 1.15 (95% CI 1.01–1.41), and OR of natural direct effect (effect unexplained by ART) was 1.72 (95% CI 0.86–2.82). The proportion mediated (natural indirect effect/total effect) was 26.5%. Adenomyosis was also significantly associated with PAS without previa (OR 1.96; 95% CI 1.23–3.13, P = 0.005).ConclusionAdenomyosis was significantly associated with PAS. ART mediated 26.5% of the association between adenomyosis and PAS.

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The association between uterine adenomyosis and adverse obstetric outcomes: A propensity score‐matched analysis

Cited by 9 publications

References 42 publications

Cervical angle as a possible predictor of abnormal placental position in women with endometriosis

Cervical angle as a possible predictor of abnormal placental position in women with endometriosis

Risk factors for placenta accreta spectrum without prior cesarean section: A case–control study in China

Association between adenomyosis and placenta accreta and mediation effect of assisted reproductive technology on the association: A nationwide observational study

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