{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T16:22:14Z","timestamp":1788538934694,"version":"build-2803163510"},"reference-count":35,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T00:00:00Z","timestamp":1679270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Uterine adenomyosis is an increasingly frequent disorder. Our study aimed to demonstrate the presence of obstetric complications in the population affected by this condition to demonstrate the need for follow-up in high-risk obstetric units. Material and Methods: The data for the study were obtained from TriNetX, LLC, between 2010 and 2020. The outcomes analyzed were intrauterine growth restriction (IUGR), preterm delivery, cesarean delivery, hypertension, abruption placentae, and spontaneous abortion. Seven thousand six hundred and eight patients were included in the cohort of pregnant patients with adenomyosis, and 566,153 women in the cohort of pregnant patients without any history of endometriosis. Results: Upon calculating the total risk of presenting any of these problems during pregnancy, we obtained an OR = 1.521, implying that a pregnancy with adenomyosis was 52.1% more likely to present some complication. We found: IUGR OR = 1.257 (95% CI: 1.064\u20131.485) (p = 0.007); preterm delivery OR = 1.422 (95% CI: 1.264\u20131.600) (p = 0.0001); cesarean delivery OR = 1.099 (95% CI: 1.002\u20131.205) (p = 0.046); hypertensive disorders OR = 1.177 (95% CI: 1.076\u20131.288) (p = 0.0001); abruption placentae OR = 1.197 (95% CI: 1.008\u20131.422) (p = 0.040), and spontaneous abortion OR = 1.529 (95% CI: 1.360\u20131.718) (p = 0.0001). Conclusion: We conclude that the review carried out and the data we obtained on increased risk provide sufficient evidence to recommend that patients with adenomyosis should be managed in obstetric high-risk units.<\/jats:p>","DOI":"10.3390\/diagnostics13061184","type":"journal-article","created":{"date-parts":[[2023,3,21]],"date-time":"2023-03-21T02:36:22Z","timestamp":1679366182000},"page":"1184","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Adenomyosis in Pregnancy\u2014Should It Be Managed in High-Risk Obstetric Units?"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7521-0676","authenticated-orcid":false,"given":"Rodrigo","family":"Orozco","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hospital Quir\u00f3nSalud, 29004 Malaga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0460-9457","authenticated-orcid":false,"given":"Jos\u00e9 Carlos","family":"Vilches","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hospital Quir\u00f3nSalud, 29004 Malaga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignacio","family":"Brunel","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hospital Quir\u00f3nSalud, 29004 Malaga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Lozano","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hospital Quir\u00f3nSalud, 29004 Malaga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4832-455X","authenticated-orcid":false,"given":"Gema","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Department of Computer Engineering, Universidad Polit\u00e9cnica, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"P\u00e9rez-Del Rey","sequence":"additional","affiliation":[{"name":"Biomedical Informatics Group, Department of Artificial Intelligence, Computer Engineering, Universidad Polit\u00e9cnica, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Meloni","sequence":"additional","affiliation":[{"name":"TriNetX LLC, Cambridge, MA 02140, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9700-0853","authenticated-orcid":false,"given":"Juan Luis","family":"Alc\u00e1zar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Cl\u00ednica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1093\/oxfordjournals.humrep.a136111","article-title":"Adenomyosis at hysterectomy: A study on frequency distribution and patient characteristics","volume":"10","author":"Vercellini","year":"1995","journal-title":"Hum. Reprod."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/j.fertnstert.2017.12.030","article-title":"Pathogenesis of uterine adenomyosis: Invagination or metaplasia?","volume":"109","author":"Donnez","year":"2018","journal-title":"Fertil. Steril."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.ejogrb.2020.08.019","article-title":"Relationship between adenomyosis and endometriosis; Different phenotypes of a single disease?","volume":"253","author":"Maruyama","year":"2020","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"94.e1","DOI":"10.1016\/j.ajog.2020.01.016","article-title":"Adenomyosis incidence, prevalence and treatment: United States population-based study 2006\u20132015","volume":"223","author":"Yu","year":"2020","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Morassutto, C., Monasta, L., Ricci, G., Barbone, F., and Ronfani, L. (2016). Incidence and Estimated Prevalence of Endometriosis and Adenomyosis in Northeast Italy: A Data Linkage Study. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0154227"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2418","DOI":"10.1093\/humrep\/16.11.2418","article-title":"Prevalence and risk factors of adenomyosis at hysterectomy","volume":"16","author":"Bergholt","year":"2001","journal-title":"Hum. Reprod."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3432","DOI":"10.1093\/humrep\/des332","article-title":"How common is adenomyosis? A prospective study of prevalence using transvaginal ultrasound in a gynaecology clinic","volume":"27","author":"Naftalin","year":"2012","journal-title":"Hum. Reprod."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.ejogrb.2014.08.016","article-title":"Prevalence of adenomyosis in women undergoing surgery for endometriosis","volume":"181","author":"Montanari","year":"2014","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.fertnstert.2018.01.006","article-title":"Symptoms and classification of uterine adenomyosis, including the place of hysteroscopy in diagnosis","volume":"109","author":"Gordts","year":"2018","journal-title":"Fertil. Steril."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/S0015-0282(01)01962-8","article-title":"Magnetic resonance imaging and transvaginal ultrasonography for the diagnosis of adenomyosis","volume":"76","author":"Dueholm","year":"2001","journal-title":"Fertil. Steril."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1002\/uog.3985","article-title":"Transvaginal sonography in the diagnosis of adenomyosis: Which findings are most accurate?","volume":"30","author":"Kepkep","year":"2007","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"529","DOI":"10.7863\/jum.2000.19.8.529","article-title":"Adenomyosis: Sonographic findings and diagnostic accuracy","volume":"19","author":"Bromley","year":"2000","journal-title":"J. Ultrasound Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1002\/uog.8900","article-title":"Adenomyosis: Three-dimensional sonographic findings of the junctional zone and correlation with histology","volume":"37","author":"Exacoustos","year":"2011","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1002\/uog.14806","article-title":"Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: A consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group","volume":"46","author":"Dueholm","year":"2015","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"107.e1","DOI":"10.1016\/j.ajog.2009.03.021","article-title":"Diagnostic accuracy of transvaginal sonography for the diagnosis of adenomyosis: Systematic review and metaanalysis","volume":"201","author":"Meredith","year":"2009","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.jmig.2017.08.653","article-title":"Transvaginal Ultrasound for the Diagnosis of Adenomyosis: Systematic Review and Meta-Analysis","volume":"25","author":"Andres","year":"2018","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.3109\/00016349.2010.512061","article-title":"Ultrasound scan and magnetic resonance imaging for the diagnosis of adenomyosis: Systematic review comparing test accuracy","volume":"89","author":"Champaneria","year":"2010","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1016\/j.jmig.2019.11.001","article-title":"Noninvasive Diagnosis of Adenomyosis: A Structured Review and Meta-analysis of Diagnostic Accuracy in Imaging","volume":"27","author":"Tellum","year":"2020","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2289","DOI":"10.1002\/jum.15635","article-title":"Diagnostic Accuracy of Transvaginal Ultrasound and Magnetic Resonance Imaging for Adenomyosis: Systematic Review and Meta-Analysis and Review of Sonographic Diagnostic Criteria","volume":"40","author":"Liu","year":"2021","journal-title":"J. Ultrasound Med."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Alc\u00e1zar, J.L., Vara, J., Usandizaga, C., Ajossa, S., Pascual, M.\u00c1., and Guerriero, S. (2022). Transvaginal ultrasound versus magnetic resonance imaging for diagnosing adenomyosis: A systematic review and head-to-head meta-analysis. Int. J. Gynaecol. Obstet.","DOI":"10.1002\/ijgo.14609"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1093\/humupd\/dms006","article-title":"Adenomyosis and subfertility: A systematic review of prevalence, diagnosis, treatment and fertility outcomes","volume":"18","author":"Maheshwari","year":"2012","journal-title":"Hum. Reprod. Update"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1055\/s-0032-1333475","article-title":"Adenomyosis and subfertility: Evidence of association and causation","volume":"31","author":"Tomassetti","year":"2013","journal-title":"Semin. Reprod. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1111\/aogs.13364","article-title":"Endometriosis and adenomyosis are associated with increased risk of preterm delivery and a small-for-gestational-age child: A systematic review and meta-analysis","volume":"97","author":"Bruun","year":"2018","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1093\/humupd\/dmz012","article-title":"Reproductive, obstetric, and perinatal outcomes of women with adenomyosis and endometriosis: A systematic review and meta-analysis","volume":"25","author":"Horton","year":"2019","journal-title":"Hum. Reprod. Update"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/0002-9378(71)90620-X","article-title":"Adenomyosis: A clinical and pathological appraisal","volume":"110","author":"Molitor","year":"1971","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1111\/aogs.13498","article-title":"Risk of preterm birth, low birthweight and small-for-gestational-age infants in pregnancies with adenomyosis: A cohort study of the Japan Environment and Children\u2019s Study","volume":"98","author":"Yamaguchi","year":"2019","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e12473","DOI":"10.1002\/rmb2.12473","article-title":"Increased risk of obstetric complications in patients with adenomyosis: A narrative literature review","volume":"21","author":"Harada","year":"2022","journal-title":"Reprod. Med. Biol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3081","DOI":"10.1007\/s43032-021-00679-z","article-title":"Adenomyosis: Impact on Fertility and Obstetric Outcomes","volume":"28","author":"Buggio","year":"2021","journal-title":"Reprod. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1097\/OGX.0000000000001042","article-title":"The Impact of Adenomyosis on Pregnancy and Pregnancy Outcomes: A Review","volume":"77","author":"Wendel","year":"2022","journal-title":"Obstet. Gynecol. Surv."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.rbmo.2020.09.023","article-title":"Fertility, pregnancy and neonatal outcomes of patients with adenomyosis: A systematic review and meta-analysis","volume":"42","author":"Nirgianakis","year":"2021","journal-title":"Reprod. Biomed. Online"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1080\/00016340500449915","article-title":"Clinical presentation and risk factors of placental abruption","volume":"85","author":"Tikkanen","year":"2006","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1002\/rmb2.12050","article-title":"Complications and outcomes of pregnant women with adenomyosis in Japan","volume":"16","author":"Tamura","year":"2017","journal-title":"Reprod. Med. Biol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1080\/25785826.2020.1809951","article-title":"Harmful and beneficial effects of inflammatory response on reproduction: Sterile and pathogen-associated inflammation","volume":"44","author":"Negishi","year":"2021","journal-title":"Immunol. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1016\/j.tjog.2019.07.004","article-title":"Uterine wall thickness at the second trimester can predict subsequent preterm delivery in pregnancies with adenomyosis","volume":"58","author":"Kim","year":"2019","journal-title":"Taiwan J. Obstet. Gynecol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Salmeri, N., Farina, A., Candiani, M., Dolci, C., Bonavina, G., Poziello, C., Vigan\u00f2, P., and Cavoretto, P.I. (2022). Endometriosis and Impaired Placentation: A Prospective Cohort Study Comparing Uterine Arteries Doppler Pulsatility Index in Pregnancies of Patients with and without Moderate-Severe Disease. Diagnostics, 12.","DOI":"10.3390\/diagnostics12051024"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/6\/1184\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:59:37Z","timestamp":1760122777000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/6\/1184"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,20]]},"references-count":35,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["diagnostics13061184"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13061184","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,20]]}}}