Geburtshilfe Frauenheilkd 2016; 76(08): 882-887
DOI: 10.1055/s-0042-107080
Original Article
GebFra Science
Georg Thieme Verlag KG Stuttgart · New York

The Role of Adenomyosis in the Pathogenesis of Preeclampsia

Die Rolle der Adenomyose in der Pathogenese der Präeklampsie
P. S. Hasdemir
1   Department of Obstetrics and Gynecology, Celal Bayar University Medical School, Manisa, Turkey
,
M. Farasat
2   Department of Radiology, Celal Bayar University Medical School, Manisa, Turkey
,
C. Aydin
1   Department of Obstetrics and Gynecology, Celal Bayar University Medical School, Manisa, Turkey
,
B. C. Ozyurt
3   Department of Public Health, Celal Bayar University Medical School, Manisa, Turkey
,
T. Guvenal
1   Department of Obstetrics and Gynecology, Celal Bayar University Medical School, Manisa, Turkey
,
G. Pekindil
2   Department of Radiology, Celal Bayar University Medical School, Manisa, Turkey
› Author Affiliations
Further Information

Publication History

received 25 January 2016
revised 07 March 2016

accepted 20 April 2016

Publication Date:
25 August 2016 (online)

Abstract

Introduction: Adenomyosis can cause defective deep placentation. Preeclampsia is known to be associated with abnormal placentation. The aim of this study was to compare the presence of adenomyosis on magnetic resonance imaging in patients with and without history of preeclampsia in order to investigate the possible role of adenomyosis in the pathogenesis of preeclampsia. Materials and Methods: This prospective, randomized study consisted of patients with (n = 35) and without (n = 34) history of preeclampsia. Direct (submucosal microcysts, adenomyoma and cystic adenomyoma) and indirect (maximal thickness of junctional zone, ratio of maximal thickness of junctional zone to myometrial thickness, junctional zone differential, focal thickening of junctional zone, globally enlarged uterus and non-uniform junctional zone contours) signs of adenomyosis were assessed by pelvic magnetic resonance imaging. Results: The prevalence of adenomyosis was found to be more common in patients with preeclampsia und fetal growth restriction compared to patients without fetal growth restriction (94.4 vs. 64.7 %; p = 0.041), respectively. There was a strong association between maximal thickness of junctional zone (9 vs. 13 mm, p = 0.005), ratio of maximal thickness of junctional zone to myometrial thickness (0.42 vs. 0.66, p = 0.001) and junctional zone differential (3 vs. 5 mm, p = 0.02) and late-onset preeclampsia. Conclusions: Presence of adenomyoma is more common in patients with preeclampsia complicated with fetal growth restriction. Indirect signs of adenomyosis detected on pelvic magnetic resonance imaging might have a role in the pathogenesis of late-onset preeclampsia.

Zusammenfassung

Einleitung: Die Adenomyose kann zu Einnistungsstörungen der Plazenta führen. Es ist bekannt, dass die Präeklampsie auf einer abnormen Plazentation beruht. Das Ziel dieser Studie bestand darin, die Adenomyose in Patientinnen mit und ohne Vorgeschichte der Präeklampsie mittels bildgebender Verfahren zu vergleichen, um die etwaige Rolle der Adenomyose bei der Pathogenese von Präeklampsie zu evaluieren. Material und Methoden: Es wurden Patientinnen mit (n = 35) oder ohne (n = 34) Vorgeschichte der Präeklampsie in diese prospektive, randomisierte Studie aufgenommen. Bei allen Patientinnen wurde eine Magnetresonanztomografie des Beckens durchgeführt, zur Beurteilung der direkten (submuköse Mikrozysten, Adenomyome und zystische Adenomyome) und indirekten (maximale Dicke der Übergangszone, Verhältnis zwischen der maximalen Dicke der Übergangszone und der Dicke des Myometriums, Differenzial der Übergangszone, fokale Verbreiterung der Übergangszone, diffus vergrößerter Uterus und irreguläre Kontur der Übergangszone) Anzeichen der Adenomyose. Ergebnisse: Die Adenomyose kam häufiger bei Patientinnen mit Präeklampsie und fetaler Wachstumsretardierung vor, verglichen mit Patientinnen ohne fetale Wachstumsretardierung (94,4 vs. 64,7 %; p = 0,041). Es bestand eine enge Verbindung zwischen der maximalen Dicke der Übergangszone (9 vs. 13 mm, p = 0,005), dem Verhältnis zwischen der maximalen Dicke der Übergangszone und der Dicke des Myometriums (0,42 vs. 0,66, p = 0,001), dem Differenzial der Übergangszone (3 vs. 5 mm, p = 0,02) und der spät einsetzenden Präeklampsie. Schlussfolgerung: Die Adenomyose kommt häufiger bei Patientinnen mit Präeklampsie und fetaler Wachstumsretardierung vor. Indirekte Anzeichen der Adenomyose, die bei einer Magnetresonanztomografie des Beckens festgestellt werden, könnten eine Rolle bei der Pathogenese von spät einsetzender Präeklampsie spielen.

 
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