Unraveling the impact of adenomyosis on obstetrical outcomes: a comprehensive review

Objective: Adenomyosis’ impact on obstetrical outcomes is investigated with detailed discussion of plausible pathogenesis. Discussion of management strategies to improve outcomes included. Methods of study: Terms utilized include ‘adenomyosis’, ‘fertility’, ‘ pregnancy’, ‘obstetrical outcomes’, ‘preeclampsia, ‘fetal growth restriction’, ‘preterm labor’, ‘preterm prelabor rupture of membranes, ‘in vitro fertilization, ‘prelabor rupture of membranes’, ‘ultrasound’, ‘small for gestational age’, ‘cesarean section’ Inclusion criteria are English, between January 1990-January 2023, randomized controlled trials, case controls, cohorts, case series, case reports, systematic reviews, and meta-analyses. Exclusion criteria are studies/articles completed prior to 1990, non-relevant, and non-English. Results: Limited literature exists evaluating the relationship between adenomyosis impact on obstetrical outcomes. However, amongst available literature there exists statistically significant relationship between adenomyosis and adverse obstetrical, neonatal outcomes such as: ectopic pregnancy, placental abruption, pre-eclampsia (PEC), gestational diabetes (GDM), low birth weight (LBW), intra-uterine growth restriction (IUGR), and preterm prelabor rupture of membranes (PPROM). Proposed physiologic mechanisms include disordered anatomic, functional, and immunological environment in the uterus. Proposed management strategies to improve obstetrical outcomes include removal of focal adenomyotic lesions and pre-treatment with GnRH agonists before conception. Conclusion: Adenomyosis has a multifactorial impact on obstetrical outcomes; treatment modalities do exist to improve the chances of conception and retaining a pregnancy. However, more research is required to not only further substantiate treatment modalities relationship to improve pregnancy; but also to clarify adenomyosis impact on infertility