Auteur(s) : Schwaab Thomas
Composante : MEDECINE
Date de création : 30-06-2019

Description : Médecine (gynécologie-obstétrique), Introduction : The prevalence of adenomyosis is unknown in France, and its impact on pregnancy is even more so. The number of pregnancies in patients with adenomyosis is constantly increasing, in line with the trend towards a decline in the age of first pregnancy. The potential obstetric complications related to this pathology pose important questions in the need to adapt our care. The main objective of this study was to study obstetric complications in patients with adenomyosis. Material and Methods : We conducted a case-control study, retrospective, single-center in Strasbourg in January 2013 to December 2017. The analysis of obstetric complications included the following variables: preeclampsia, postpartum hemorrhage, premature rupture of membranes , premature birth, the incidence of small weights for gestational age and the mode of delivery. The control group was selected from women who gave birth in 2017 and whose first trimester ultrasound confirmed that they were free of the disease. Controls were matched in a ratio of 2: 1 according to age, parity, and history of premature delivery. Results : 83 patients who were diagnosed with MRI adenomyosis were included in this study and randomization selected 166 controls. Patients suffering from adenomyosis more gave birth by caesarean section (39% vs. 14% p -0.001), had more deliveries before 37 weeks (20% versus 4% p -0.001), more bleeding (14% vs 1% p -0.001), more premature rupture of the membranes (14% versus 2% p -0.001) and the PAG index was higher (21% versus 11% p = 0.02). In multivariate analysis, there was a 3.17-fold increase in caesarean section risk (95% CI [1.6077, 6.25], p = 0.0008), a risk of hemorrhage 8.18 times greater (95% CI [1.7774, 58.2922], p = 0.0131), a risk of premature rupture of membranes 4.30 times greater (95% CI [1.0046, 22.2358]), p = 0.0466), a pre-eclampsia risk of 3.68 times greater (95% CI [0.9363; 15.7149], p = 0.0627) and about 2.09 times more miscarriage (95% CI [ 1.3635; 3.3332], p = 0.0011). Conclusion: This study demonstrated that adenomyosis was associated not only with an increase in the incidence of premature rupture of membranes, but also with an increased risk of postpartum hemorrhage, pre-eclampsia, and caesarean section. resulting in adverse neonatal consequences. This original work deserves to be completed in the years to come, to study the evolution of the management of this pathology which tends to be better known to the general public, at a time when therapeutic strategies evolve rapidly.
Mots-clés libres : Grossesse -- Complications (médecine), 617.6, 618.1-8
Couverture : FR