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      Complications and outcomes of pregnant women with adenomyosis in Japan

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          Abstract

          Purpose

          To investigate the impact of adenomyosis on the complications and outcomes of pregnancy in Japan.

          Methods

          We carried out a multicenter retrospective questionnaire survey. A questionnaire regarding pregnancy complications and the outcomes of pregnancy was sent to 725 facilities.

          Results

          Data were obtained on the cases of 272 pregnant women with adenomyosis from 65 facilities. The complications of pregnancy included miscarriage before 12 weeks of pregnancy (14.8%), miscarriage after 12 weeks of pregnancy (9.9%), preterm delivery (24.4%), fetal growth restriction (11.8%), pregnancy‐induced hypertension (9.9%), intrauterine infection (7.3%), and cervical incompetency (5.3%). The rates of pregnancy complications in the three groups classified according to pretreatment for adenomyosis (no pretreatment, medication, surgery) did not differ to a statistically significant extent. The rates of miscarriage (>12 weeks) and cervical incompetency increased according to the size of the adenomyosis. The rates of pregnancy‐induced hypertension and uterine infection in patients with diffuse‐type adenomyosis were higher than that in patients with focal‐type adenomyosis.

          Conclusions

          Our results show that the increased size and diffuse type of adenomyosis are associated with adverse pregnancy outcome. We should be aware of the higher incidence of pregnancy‐induced hypertension and uterine infection in patients with diffuse‐type adenomyosis.

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          Adenomyosis in endometriosis--prevalence and impact on fertility. Evidence from magnetic resonance imaging.

          P. Huppert, D Beil, M Noe … (2005)
          The hypothesis is tested that there is a strong association between endometriosis and adenomyosis and that adenomyosis plays a role in causing infertility in women with endometriosis. METHODS. Magnetic resonance imaging of the uteri was performed in 160 women with and 67 women without endometriosis. The findings were correlated with the stage of the disease, the age of the women and the sperm count parameters of the respective partners. The posterior junctional zone (PJZ) was significantly thicker in women with endometriosis than in those without the disease (P<0.001). There was a positive correlation of the diameter of the PJZ with the stage of the disease and the age of the patients. The PJZ was thicker in patients with endometriosis with fertile than in patients with subfertile partners. The prevalence of adenomyotic lesions in all 160 women with endometriosis was 79%. In women with endometriosis below an age of 36 years and fertile partners, the prevalence of adenomyosis was 90% (P<0.01) With a prevalence of up to 90%, uterine adenomyosis is significantly associated with pelvic endometriosis and constitutes an important factor of sterility in endometriosis presumably by impairing uterine sperm transport.
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            Distribution of cyclooxygenase-2 in eutopic and ectopic endometrium in endometriosis and adenomyosis.

            H Ota, Mark M. Sasaki, S Igarashi … (2001)
            The objective of this study was to determine the distribution of cyclooxygenase-2 (COX-2) in eutopic and ectopic endometria in endometriosis and adenomyosis. The subjects were 35 patients with endometriosis diagnosed by laparoscopy, 33 patients with histologically confirmed adenomyosis and 50 female controls with normal fecundity. Expression of COX-2 was immunohistochemically investigated in tissues from eutopic endometrium and myometrium and ectopic endometrium of the wall of ovarian chocolate cysts using polyclonal antibody. Surface epithelial cells, endometrial glandular epithelial cells or stromal cells were assessed. Cells were semi-quantitatively assessed on a scale of 1 to 5 using a nomogram created from positive cell count and the degree of staining. COX-2 expression in surface and glandular epithelia of the control group varied markedly during the menstrual cycle. It was lowest in the early proliferative phase and gradually increased thereafter. It remained high throughout the secretory phase. However, in patients with endometriosis, expression of COX-2 in glandular epithelium was higher than that in the control group, though it varied throughout the menstrual cycle. On the other hand, there was no variation in expression of COX-2 in the adenomyosis group during the menstrual cycle, and it was lower than that in the endometriosis group in all phases. Pronounced COX-2 expression was observed in glandular cells from ectopic endometrial tissue of ovarian chocolate cyst walls in all cases regardless of the menstrual phase. In summary, increased COX-2 expression in eutopic and ectopic endometria was believed to be strongly correlated with pathological abnormalities in these disorders.
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              Restricted fetal growth in sudden intrauterine unexplained death.

              J Frederik Frøen, Jason Gardosi, Anne Thurmann … (2004)
              Unexplained antepartum stillbirth is a common cause of perinatal death, and identifying the fetus at risk is a challenge for obstetric practice. Intrauterine growth restriction (IUGR) is associated with a variety of adverse perinatal outcomes, but reports on its impact on unexplained stillbirths by population-based birthweight standards have been varying, including both unexplained and unexplored stillbirths. We have studied IUGR, assessed by individually adjusted fetal weight standards, in antepartum deaths that remained unexplained despite thorough postmortem investigations. Antenatal health cards from a complete population-based 10-year material of 76 validated sudden intrauterine unexplained deaths were compared to those of 582 randomly selected liveborn controls. Birthweight <10th percentile of the individualized standard adjusted for gestational age, maternal height, weight, parity, ethnicity, and fetal gender was defined as growth restriction. 52% of unexplained stillbirths were growth restricted, with a mean gestational age at death of 35.1 weeks. Suboptimal growth was the most important fetal determinant for sudden intrauterine unexplained death (odds ratio 7.0, 95% confidence interval 3.3-15.1). Concurrent maternal overweight or obesity, high age, and low education further increase the risk. Overweight and obesity increase the risk irrespective of fetal growth, and while high maternal age increases the risk of the normal weight fetus, it is not associated to growth restriction as a precursor of sudden intrauterine unexplained death. IUGR is an important risk factor of sudden intrauterine unexplained death, and this should be excluded in pregnancies with any other risk factor for sudden intrauterine unexplained death.
              Article 0 comments Cited 45 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Hiroshi Tamura:
                ORCID: http://orcid.org/0000-0001-6258-4572
                hitamura@yamaguchi-u.ac.jp
                Journal
                Journal ID (nlm-ta): Reprod Med Biol
                Journal ID (iso-abbrev): Reprod. Med. Biol
                Journal ID (doi): 10.1111/(ISSN)1447-0578
                Journal ID (publisher-id): RMB2
                Title: Reproductive Medicine and Biology
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 1445-5781
                ISSN (Electronic): 1447-0578
                Publication date (Electronic): 21 August 2017
                Publication date Collection: October 2017
                Volume: 16
                Issue: 4 ( doiID: 10.1111/rmb2.2017.16.issue-4 )
                Pages: 330-336
                Affiliations
                [ 1 ] Department of Obstetrics and Gynecology Yamaguchi University Graduate School of Medicine Ube Japan
                [ 2 ] Department of Obstetrics and Gynecology Gunma University Graduate School of Medicine Maebashi Japan
                [ 3 ] Department of Obstetrics and Gynecology Juntendo University School of Medicine Tokyo Japan
                [ 4 ] Department of Obstetrics and Gynecology Yokohama City University Hospital Yokohama Japan
                [ 5 ] Saint Mother Obstetrics and Gynecology Clinic Institute for ART Fukuoka Japan
                [ 6 ] Department of Obstetrics and Gynecology Shiga University of Medical Science Otsu Japan
                Author notes
                [*] [* ] Correspondence

                Hiroshi Tamura, Department of Obstetrics and Gynecology, Yamaguchi University Graduate School of Medicine, Ube, Japan.

                Email: hitamura@ 123456yamaguchi-u.ac.jp

                Author information
                http://orcid.org/0000-0001-6258-4572
                http://orcid.org/0000-0001-5299-2505
                Article
                Publisher ID: RMB212050
                DOI: 10.1002/rmb2.12050
                PMC ID: 5715891
                PubMed ID: 29259486
                SO-VID: 2593e773-35ba-4083-bf19-bff882705fe1
                Copyright © © 2017 The Authors. Reproductive Medicine and Biology published by John Wiley & Sons Australia, Ltd on behalf of Japan Society for Reproductive Medicine.
                License:

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                Date received : 27 June 2017
                Date accepted : 09 July 2017
                Page count
                Figures: 1, Tables: 3, Pages: 7, Words: 5040
                Categories
                Subject: Original Article
                Subject: Original Articles
                Custom metadata
                source-schema-version-number 2.0
                component-id rmb212050
                cover-date October 2017
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:5.2.7 mode:remove_FC converted:04.12.2017

                Keywords: adenomyosis,complication,miscarriage,pregnancy,preterm delivery
                Data availability:
                Keywords: adenomyosis, complication, miscarriage, pregnancy, preterm delivery

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