探讨不同类型子宫腺肌症女性的妊娠和围产结局！

OBJECTIVE

目的

To evaluate the maternal and fetal outcomes in women with diffuse or focal adenomyosis and investigate the effect of placental attachment position on pregnancy outcomes in patients with focal adenomyosis.

探讨弥漫性或局限性子宫腺肌症患者的母体和胎儿结局，并探讨胎盘附着部位对局限性子宫腺肌症患者妊娠结局的影响。

MATERIALS AND METHODS

材料和方法

This retrospective cohort study analyzed 256 patients with adenomyosis who underwent deliveries between January 2014 and December 2019 at our obstetrical department. All patients were divided into the following two groups according to adenomyosis phenotypes: the diffuse group (n = 119) and the focal group (n = 137). In addition, the focal group was divided into the lesion-attached (n = 77) and -unattached subgroups (n = 60) based on the placental attachment position.

本次回顾性队列研究分析了2014年1月至2019年12月在我院产科分娩的256例子宫腺肌病患者。所有患者根据子宫腺肌症类型分为以下两组：弥漫性组（n=119）和局限性组（n=137）。此外，根据胎盘附着位置将局限性组分为2个亚组，即病灶附着组（n=77）和病灶未附着组（n=60)。

RESULTS

结果

The groups were comparable between placental abnormalities, including the rate of preeclampsia, placenta previa, placental abruption, and placenta implantation. However, more blood volume was easily lost during delivery when the placenta was attached to the adenomyosis lesion in focal adenomyosis (406.2 ± 368.1ml vs. 312.9 ± 143.2ml, P = 0.048) and when referred to diffuse adenomyosis (513.0 ± 613.3ml vs.364.8 ± 293.4ml, P = 0.024). In addition, the premature delivery rate was significantly higher in the lesion-attached subgroup than in the lesion-unattached subgroup(20.8% vs. 6.7%, P = 0.027). Furthermore, in the multivariate logistic regression analysis, the postpartum hemorrhage rate was unaffected by the different adenomyosis phenotypes and placental attachment. However, the position of placental attachment (P = 0.049, odds ratio (OR): 5.228, 95% confidence interval (CI): 1.008–27.124)and placenta previa (P = 0.049, OR: 9.775, 95% CI: 1.010–94.610) were independently and significantly linked with predicting the occurrence of premature delivery in focal adenomyosis.

弥漫性和局限性子宫腺肌症组在胎盘异常性疾病，包括子痫前期、前置胎盘、胎盘早剥和胎盘植入的发生率相似。然而，当胎盘附着于子宫腺肌病病灶时，在分娩过程中容易丢失更多的血量，局限性组（406.2±368.1ml vs. 312.9±143.2ml，P=0.048）和弥漫性组（513.0± 613.3ml vs. 364.8±293.4ml，P=0.024）。亚组分析发现，局限性子宫腺肌症病灶附着组的早产率明显高于病灶未附着亚组（20.8% vs. 6.7%，P=0.027）。此外，在多因素logistic回归分析中，产后出血发生率不受子宫腺肌病类型和胎盘附着的影响。然而，胎盘附着（P=0.049，比值比OR：5.228，95%置信区间CI：1.008–27.124）和前置胎盘（P=0.049，比值比OR：9.775，95%CI：1.010–94.610）是独立预测局限性子宫腺肌病早产发生的显著因素。

CONCLUSIONS

结论

The position of the placenta (lesion-attached or -unattached) in patients with focal adenomyosis independently and significantly affected premature delivery.

局限性子宫腺肌病患者的胎盘附着（病灶附着或不附着）是独立且显著影响早产的因素。

IMPACT STATEMENT

影响陈述

This information maybe helpful in clinical decision-making of pregnancy monitoring and delievery for patients with adenomyosis.

这些信息可能有助于子宫腺肌病患者的妊娠监测和分娩临床决策。

表1.根据局限性子宫腺肌病患者的胎盘附着部位分组的研究队列的妊娠和围产结局

文章来源：

PREGNANCY AND PERINATAL OUTCOMES IN WOMEN WITH DIFFERENT PHENOTYPES OF ADENOMYOSISYang, WanFertility and Sterility, Volume 120, Issue 4, e63 - e64