Deep Infiltrating Endometriosis and Adenomyosis: Implications on Pregnancy and Outcome.

Teresa Mira Gruber,Wolfgang Henrich,Sylvia Mechsner,Laura Ortlieb

doi:10.3390/jcm11010157

Abstract

Endometriosis (EM), especially deep infiltrating endometriosis (DIE) and adenomyosis (AM), are known to cause pain and sterility in young women. More recently, they have also been described as risk factors for obstetric complications. While the pathophysiology is not yet completely understood, they seem to share a common origin: archimetrosis. Methods: A systematic literature review was conducted to summarize the existing evidence on DIE and AM as risk factors for obstetric complications. Results: Preterm birth, caesarean section delivery (CS) and placental abnormalities are associated with the diagnosis of DIE and AM. Women with AM seem to experience more often hypertensive pregnancy disorders, premature rupture of membranes and their children are born with lower birth weights than in the control groups. However, many of the studies tried to evaluate AM, EM and DIE as separate risk factors. Moreover, often they did not adjust for important confounders such as multiple pregnancies, parity, mode of conception and maternal age. Therefore, prospective studies with larger numbers of cases and appropriate adjustment for confounders are needed to explore the pathophysiology and to prove causality.

Highlights

With involvement of the junctional zone (JZ), and focal adenomyosis located in the outer myometrium (FOAM) often described in association with deep infiltrating endometriosis (DIE)
Two reviews, three prospective and two retrospective cohort studies and three retrospective case-control studies on obstetric complications in patients with AM, which
Two reviews, three prospective and two retrospective cohort studies and three retrospective case-control studies on obstetric complications in patients with AM, which included

Summary

Introduction

EM is a common disease: 10% of all women between 15 and 45 years are affected [1,2]. The disease is characterized by endometrial-like tissue dispersed in other locations than the uterine cavity. One common theory of the origin of EM is the translocation of endometrial tissue by retrograde menstruation formulated by Sampson in 1927 [3]. To explain why only some women develop EM even though retrograde menstruation is a very common phenomenon, the metaplasia theory was created and adapted over the years according to new scientific evidence [4]. Lesions that infiltrate more than 5 mm into the affected tissue are considered DIE. AM is defined by endometrial-like lesions in the myometrium. There are different forms: diffuse AM with involvement of the junctional zone (JZ), and focal adenomyosis located in the outer myometrium (FOAM) often described in association with DIE. There are concepts of metaplasia, inner and outer invasion, or invagination [6]

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