Adverse Obstetrical Outcomes in Adenomyosis and Correlation With #Enzian Score: A Retrospective Study

Abstract

Objective: To analyse the prevalence of adverse obstetrical and neonatal outcomes in women with adenomyosis within a Dutch hospital, and assess correlation with the #Enzian classification.

Study Design: Retrospective observational cohort study.

Setting: The study was conducted at the Endometriosis Expertise Centre of Haaglanden Medical Centre (HMC), The Hague, the Netherlands.

Population: Women diagnosed with adenomyosis who delivered at HMC between January 1, 2017, and March 31, 2024 (n=196).

Methods: Data were extracted from electronic medical records. Outcomes were compared to national data from the Dutch Perinatal Register and literature.

Main Outcome Measures: Prevalence of obstetrical and neonatal complications.

Results: Compared to the general population, women with adenomyosis showed higher prevalence of prior caesarean sections (14.9% vs 7.4%, p=0.0001), and a history of hypertensive disorders in previous pregnancies (3.1% vs 0.6%, p<0.0001), subfertility (58.7% vs 16%, p<0.0001), fetal growth restriction (FGR) (6.5% vs 3.3%, p=0.03), placenta praevia (3.3% vs 0.84%, p=0.009), non-progressive labour (26.7% vs 11.8%, p<0.0001), assisted vaginal deliveries (12.3% vs 6.8%, p=0.008), induction of labour (34.4% vs 28.3%, p=0.004), and both elective (25.3% vs 9.4%, p<0.0001) and emergency (14.9% vs 8.3%, p=0.004) caesarean sections. A statistically significant but uncertain correlation was found between the presence of adenomyosis and involvement of #Enzian domains T and A.

Conclusion: Women with adenomyosis are at increased risk of adverse pregnancy outcomes. Further research is needed to explore the role of adenomyosis in obstetrical and neonatal outcomes more comprehensively, including the extent and location of endometriosis using #Enzian classification.