270 Despite most of the published studies reporting convincing evidence associating adenomyosis with obstetric complications, common weaknesses of these studies limit their generalizability. First, they have relatively small sample sizes, with the largest study including 245 women with adenomyosis (101,110). Previous studies have made use of less reliable diagnostic methods such as TVUS (105) and MRI (4,102), with the larger published studies relying on self-reported diagnosis (104,110). Nevertheless, no studies exist on obstetric outcomes in combination with histopathological adenomyosis diagnosis. Hence, women with adenomyosis are not generally considered as having high-risk or complicated pregnancies. Consequently, no guidelines exist for the management of pregnant women diagnosed with adenomyosis. Large-scale studies are needed to yield unambiguous results that can impact the clinical practice and (obstetric) management of women, preferably using the diagnostic gold standard of histopathology.
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