Introduction
Uterine adenomyosis is a benign disorder in which endometrial tissues
are present within the myometrium, and it is associated with abnormal
uterine bleeding, dysmenorrhea, pelvic pain, and infertility.(1) (2)
Moreover, adenomyosis is also known to be associated with unfavorable
perinatal outcomes, with increased incidence of preterm delivery,
preeclampsia (PE), cesarean delivery, postpartum hemorrhage (PPH), and
small for gestational age infants. (3-8) However, the pathophysiology
underlying this etiology remains to be elucidated, along with the
clinical factors associated with adenomyosis that are responsible for
these outcomes.
Several cases of adenomyosis accompanied by severe pain and enhanced
inflammatory response during pregnancy that showed degenerative changes,
which were confirmed with magnetic resonance imaging, have been reported
since 2006, including one from our institution.(9) (10) (11)
Intriguingly, all of the cases developed either preterm delivery,
miscarriage, preeclampsia, or non-reassuring fetal status. Although
fibroids are reported to degenerate during pregnancy and cause pain and
enhanced inflammation in 12.6-28.0% of these
women,(12),(13) the incidence of pain and enhanced
inflammation during pregnancy among women with adenomyosis has not been
reported, nor has its degeneration during pregnancy and its impact on
perinatal outcomes.
Our main objective was to evaluate the clinical characteristics of pain
at the adenomyosis site during pregnancy. We also compared perinatal
outcomes between those who experienced pain and those who did not among
pregnant women with adenomyosis to investigate whether this pain,
suggesting degeneration during pregnancy, affects perinatal outcomes.