Outcome of pregnancy after adenomyomectomy: a review
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Adenomyosis, a prevalent yet frequently underdiagnosed uterine disorder, poses significant challenges for women of reproductive age, especially those seeking fertility. Although hysterectomy remains the definitive treatment, fertility-sparing interventions such as adenomyomectomy have gained traction despite ongoing debates regarding their efficacy and safety. This review synthesizes the current evidence on reproductive and perinatal outcomes following adenomyomectomy, evaluates its risks and benefits and provides evidence-based clinical recommendations. We reviewed the diagnosis and treatment of adenomyosis, with a particular focus on fertility-sparing surgery, and summarized the pregnancy outcomes and obstetric risks after adenomyomectomy, including recommendations for prenatal care. Adenomyomectomy may improve fertility in carefully selected patients; however, it carries substantial obstetric risks including placenta accreta spectrum, preterm birth, and life-threatening hemorrhage. While it offers a viable alternative to hysterectomy, its use should be restricted to women with severe symptoms or those who have failed assisted reproductive technology cycles and should be managed within a framework of shared decision-making and high-risk obstetric care. Future research should address diagnostic standardization, long-term reproductive outcomes, and strategies to mitigate surgical complications.
Abstract
Adenomyosis, a prevalent yet frequently underdiagnosed uterine disorder, poses significant challenges for women of reproductive age, especially those seeking fertility. Although hysterectomy remains the definitive treatment, fertility-sparing interventions such as adenomyomectomy have gained traction despite ongoing debates regarding their efficacy and safety. This review synthesizes the current evidence on reproductive and perinatal outcomes following adenomyomectomy, evaluates its risks and benefits and provides evidence-based clinical recommendations. We reviewed the diagnosis and treatment of adenomyosis, with a particular focus on fertility-sparing surgery, and summarized the pregnancy outcomes and obstetric risks after adenomyomectomy, including recommendations for prenatal care. Adenomyomectomy may improve fertility in carefully selected patients; however, it carries substantial obstetric risks including placenta accreta spectrum, preterm birth, and life-threatening hemorrhage. While it offers a viable alternative to hysterectomy, its use should be restricted to women with severe symptoms or those who have failed assisted reproductive technology cycles and should be managed within a framework of shared decision-making and high-risk obstetric care. Future research should address diagnostic standardization, long-term reproductive outcomes, and strategies to mitigate surgical complications.