摘要目的 探讨妊娠合并不同类型子宫腺肌病对母儿结局的影响。方法 采用回顾性分析方法,选择北京大兴区人民医院2012-05至2022-04妊娠合并弥漫型子宫腺肌病94例为观察组A,妊娠合并局灶型子宫腺肌病91例为观察组B,与观察组A、B同一分娩日期但未合并腺肌病的分娩孕妇740例为对照组。分析比较三组的一般资料及不良母儿结局。结果 观察组A、B与对照组一般基线资料比较,年龄、BMI、孕产次等无统计学差异。与对照组比较,观察组A子痫前期、未足月胎膜早破、早产、低出生体重儿发生率增高(分别为21.3% vs. 4.5%,P<0.001;6.4% vs. 1.6%,P=0.003;25.5% vs. 3.9%,P<0.001;6.4% vs. 1.2%,P<0.001),而观察组B相应发生率并不增高(4.4%,P=0.978;2.2%,P=0.687;4.4%,P=0.826;2.2%、0.9%,P=0.439)。与对照组比较,观察组A、B产后出血率、难治性产后出血率、输血率及ICU入住率明显增高(分别为39.4%、39.6% vs. 0.8%,P<0.001;7.4% 、4.4% vs. 0.1%,P<0.001;7.4%、4.4% vs. 0.4%,P<0.001;7.4%、4.4% vs. 0.5%,P<0.001);且观察组A与B之间无统计学差异。结论 妊娠合并子宫腺肌病发生子痫前期、未足月胎膜早破、早产、低出生体重儿风险明显增加,尤以弥漫型子宫腺肌病为著,而局灶型子宫腺肌病并未增加以上风险。但无论弥漫型,还是局灶型子宫腺肌病,均容易导致难治性产后出血,具有较高的输血率、ICU入住率及新生儿住院率。
Abstract：Objective To explore the influence of pregnancy complicated with different types of adenomyosis on the outcome of mothers and babies.Methods Ninety-four cases of pregnancy complicated with diffuse adenomyosis in Daxing District People's Hospital of Beijing from May 2012 to April 2022 were retrospectively analyzed as observation group A, 91 cases of pregnancy complicated with focal adenomyosis as observation group B, and 740 cases of delivery with the same delivery date but without adenomyosis as control group. The general data and adverse maternal and infant outcomes of the three groups were compared.Results Compared with the general baseline data of the observation group A and B, there was no statistical difference in age, BMI, pregnancy and childbirth. Compared with the control group, the incidence of preeclampsia, premature rupture of membranes, premature delivery and low birth weight infants in observation group A increased (respectively 21.3% vs. 4.5%, P<0.001; 6.4% vs. 1.6%,P=0.003; 25.5% vs. 3.9%,P<0.001; 6.4% vs. 1.2%, P<0.001), while observation group B did not increase the corresponding incidence (4.4%, P=0.978; 2.2%,P=0.687; 4.4%,P=0.826; 2.2%、0.9%,P=0.439). Compared with the control group, the postpartum hemorrhage rate, refractory postpartum hemorrhage rate, blood transfusion rate and ICU occupancy rate in observation group A and group B were significantly higher (39.4%,39.6% vs. 0.8%, P<0.001; 7.4%,4.4% vs. 0.1%,P<0.001; 7.4%,4.4% vs. 0.4%,P<0.001; 7.4%,4.4% vs. 0.5%,P<0.001);and there was no statistical difference between Group A and Group B.Conclusions Preeclampsia, preterm premature rupture of membranes, premature delivery and low birth weight infants in pregnancy complicated with adenomyosis obviously increase the risk, especially diffuse adenomyosis, but focal adenomyosis does not increase the above risk. However, whether it is diffuse or focal adenomyosis, it is easy to cause intractable postpartum hemorrhage, with high blood transfusion rate, ICU occupancy rate and neonatal hospitalization rate.
刘萍, 马丽丽, 宋风丽. 妊娠合并不同类型子宫腺肌病对母儿结局的影响[J]. 武警医学, 2022, 33(12): 1028-1032.
LIU Ping, MA Lili, SONG Fengli. Influence of different types of adenomyosis in pregnancy on maternal and fetal outcomes. Med. J. Chin. Peop. Armed Poli. Forc., 2022, 33(12): 1028-1032.
Yu O, Schulze-Rath R, Grafton J, et al. Adenomyosis incidence, prevalence and treatment: United States population-based study 2006-2015[J]. Am J Obstet Gynecol, 2020, 223(1): 94. e1-94.e10.
[2]
Buggio L, Monti E, Gattei U, et al. Adenomyosis: fertility and obstetric outcome. A comprehensive literature review[J]. Minerva Ginecol, 2018, 70(3): 295-302.
[3]
Harada T, Taniguchi F, Amano H, et al. Adverse obstetrical outcomes for women with endometriosis and adenomyosis: a large cohort of the Japan environment and children's study[J]. PLoS One, 2019, 14(8): e0220256.
[4]
Jensen K K, Pyle C, Foster B R, et al. Adenomyosis in pregnancy: diagnostic pearls and pitfalls[J]. Radiographics, 2021, 41(3): 929-944.
[5]
Razavi M, Maleki-Hajiagha A, Sepidarkish M, et al. Systematic review and meta-analysis of adverse pregnancy outcomes after uterine adenomyosis[J]. Int J Gynaecol Obstet, 2019, 145(2): 149-157.
[6]
Sharma S, Bathwal S, Agarwal N, et al. Does presence of adenomyosis affect reproductive outcome in IVF cycles? A retrospective analysis of 973 patients[J].Reprod Biomed Online,2019, 38(1): 13-21.
[7]
Shinohara S, Okuda Y, Hirata S, et al. Adenomyosis as a potential risk factor for adverse pregnancy outcomes: a multicenter case-control study[J]. Tohoku J Exp Med, 2020, 251(3): 231-239.
[8]
Hashimoto A, Iriyama T, Sayama S, et al. Adenomyosis and adverse perinatal outcomes: increased risk of second trimester miscarriage, preeclampsia, and placental malposition[J].J Matern Fetal Neonatal Med, 2018, 31(3): 364-369.
[9]
Chapron C, Vannuccini S, Santulli P, et al. Diagnosing adenomyosis: an integrated clinical and imaging approach[J]. Hum Reprod Update, 2020, 26(3): 392-411.
[10]
Cunningham R K, Horrow M M, Smith R J, et al. Adenomyosis: a sonographic diagnosis[J]. Radiographics, 2018, 38(5): 1576-1589.
[11]
Vannuccini S, Petraglia F. Recent advances in understanding and managing adenomyosis[J]. F1000 Res, 2019, 8(F1000 Faculty Rev):283-292.
Rees C O, Nederend J, Mischi M, et al. Objective measures of adenomyosis on MRI and their diagnostic accuracy—a systematic review & meta-analysis[J]. Acta Obstet Gynecol Scand, 2021, 100(8): 1377-1391.
[14]
Brosens I, Puttemans P, Benagiano G. Placental bed research: I. The placental bed: from spiral arteries remodeling to the great obstetrical syndromes[J]. Am J Obstet Gynecol, 2019, 221(5): 437-456.
[15]
Kalapotharakos G, Murtoniemi K, Åkerström B, et al. Plasma heme scavengers alpha-1-microglobulin and hemopexin as biomarkers in high-risk pregnancies[J].Front Physiol, 2019, 10: 300.
[16]
Gyselaers W. Preeclampsia is a syndrome with a cascade of pathophysiologic events[J]. J Clin Med, 2020, 9(7): 2245.
[17]
Roth C J, Haeussner E, Ruebelmann T, et al. Dynamic modeling of uteroplacental blood flow in IUGR indicates vortices and elevated pressure in the intervillous space-a pilot study[J].Sci Rep, 2017, 7(1): 1-11.
[18]
Hashimoto A, Iriyama T, Sayama S, et al. Adenomyosis and adverse perinatal outcomes: increased risk of second trimester miscarriage, preeclampsia, and placental malposition[J].J Matern Fetal Neonatal Med, 2018, 31(3): 364-369.
[19]
Razavi M, Maleki-Hajiagha A, Sepidarkish M, et al. Systematic review and meta-analysis of adverse pregnancy outcomes after uterine adenomyosis[J]. Int J Gynaecol Obstet, 2019, 145(2): 149-157.
[20]
Teklay G, Teshale T, Tasew H, et al. Risk factors of preterm birth among mothers who gave birth in public hospitals of central zone, Tigray, Ethiopia: unmatched case-control study 2017/2018[J].BMC Res Notes, 2018, 11(1): 1-7.
[21]
Deressa A T, Cherie A, Belihu T M, et al. Factors associated with spontaneous preterm birth in Addis Ababa public hospitals, Ethiopia: cross sectional study[J].BMC Pregnancy Childbirth,2018,18(1):332.
[22]
Mulualem G, Wondim A, Woretaw A. The effect of pregnancy induced hypertension and multiple pregnancies on preterm birth in Ethiopia: a systematic review and meta-analysis[J]. BMC Res Notes, 2019, 12(1): 1-7.
[23]
Premkumar A, Baer R J, Jelliffe-Pawlowski L L, et al. Hypertensive disorders of pregnancy and preterm birth rates among black women[J]. Am J Perinatol, 2019, 36(2): 148-154.
[24]
Lawn J E, Gravett M G, Nunes T M, et al. Global report on preterm birth and stillbirth (1 of 7): definitions, description of the burden and opportunities to improve data[J]. BMC Pregnancy Childbirth, 2010, 10(1): 1-22.
[25]
Yamaguchi A, Kyozuka H, Fujimori K, et al. 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's study[J]. Acta Obstet Gynecol Scand, 2019, 98(3): 359-364.
[26]
Bourdon M, Santulli P, Jeljeli M, et al. Immunological changes associated with adenomyosis: a systematic review[J]. Hum Reprod Update, 2021, 27(1): 108-129.
[27]
Mochimaru A, Aoki S, Oba M S, et al. Adverse pregnancy outcomes associated with adenomyosis with uterine enlargement[J]. J Obstet Gynaecol Res, 2015, 41(4): 529-533.
[28]
Khan K N, Fujishita A, Suematsu T, et al. An axonemal alteration in apical endometria of human adenomyosis[J]. Hum Reprod, 2021, 36(6): 1574-1589.
[29]
Khan K N, Fujishita A, Koshiba A, et al. Biological differences between focal and diffuse adenomyosis and response to hormonal treatment[J].Reprod Biomed Online, 2019, 38(4): 634-646.
[30]
Mochimaru A, Aoki S, Oba M S, et al. Adverse pregnancy outcomes associated with adenomyosis with uterine enlargement[J]. J Obstet Gynaecol Res, 2015, 41(4): 529-533.
2022, Vol. 33 
