The Prevalence and Clinical Impact of Adenomyosis in Pregnancy-Related Hysterectomy

Abstract

Background: The epidemiology of adenomyosis has been traditionally based on patients undergoing hysterectomy for gynecological indications, while its prevalence among hysterectomies performed for obstetric complications is unknown. The aim of this study was to assess the prevalence and clinical impact of adenomyosis diagnosed through histology among women undergoing pregnancy-related hysterectomy (PH). Methods: This was a retrospective cohort study. Women who delivered at a tertiary care regional obstetric hub in Milan between 2009 and 2020 were reviewed to identify cases of PH. Histopathological reports of surgical specimens were examined. Cases with adenomyosis were compared to those without adenomyosis for baseline characteristics, obstetric history and outcomes. Results: During the study period there were 71,061 births and a total of 130 PH, giving a PH incidence of 1.83 per 1000 deliveries. Adenomyosis cases were 18, giving a prevalence of 13.8%. Adenomyosis was associated with placenta previa (77.8 vs. 45.5%, p = 0.01), chorionamnionitis (27.8 vs. 5.4%, p = 0.008), lower gestational age at birth (32 ± 4.6 vs. 35.5 ± 3.6 weeks’ gestation, p = 0.0004), and intrauterine fetal demise among twin pregnancies (50 vs. 4.5%, p = 0.048). Conclusion: Adenomyosis entails a relevant impact on obstetric and perinatal outcomes related to PH. More evidence is needed on the clinical relevance of an ultrasonographic diagnosis of adenomyosis before conception.

Adenomyosis among patients undergoing postpartum hysterectomy for uncontrollable uterine bleeding: A multicenter, observational, retrospective, cohort study on histologically‐based prevalence and clinical characteristics

“…32 related obstetric complications, peripartum maternal clinical characteristics, and neonatal birth weights. We observed a 39% prevalence of adenomyosis in this cohort of patients, a higher rate than that reported by Orsi et al 33 This discrepancy suggests that adenomyosis may not only be a risk factor for postpartum hysterectomy but could also play a role in patients experiencing PPH unresponsive to conservative treatments.…”

“…Abnormal uterine contractility has been previously linked to (outer myometrium) adenomyosis. 38 However, our data show no significant difference in terms of uterine atony between the two study groups, aligning with findings by Orsi et al 33 Indeed, abnormal myometrial angiogenesis, intimately related to adenomyosis, might have played a significant role in the pathogenesis of PPH. 17,39,40 Regarding the mode of delivery, C-section was the most common modality in both groups.…”

“…Recently, Orsi et al. expanded the investigation to the role of adenomyosis in women undergoing postpartum hysterectomy during the puerperal period for various indications, 33 demonstrating a prevalence of adenomyosis of 13.8% based on pathologic examination. Our study may be the first to assess the prevalence of adenomyosis in patients undergoing postpartum hysterectomy exclusively due to PPH and examine related obstetric complications, peripartum maternal clinical characteristics, and neonatal birth weights.…”