272 Study Outcomes: The prevalence of adverse obstetric outcomes in women with adenomyosis was compared to the women without reported histopathological adenomyosis from the general Dutch population. The primary outcomes of this study are summarised in Table 11.S1. Primary outcomes for this study included a variety of adverse obstetric outcomes: mode of delivery, preterm birth (PTB, delivery <37 weeks gestational age), failure to progress, placental retention, postpartum haemorrhage (PPH), hypertensive disorders of pregnancy (HDP), foetal growth restriction (FGR, biometry < 10th percentile), and small for gestational age (SGA, birthweight <10th percentile). Neonatal outcomes assessed included: perinatal mortality, low (<7) Apgar scores, neonatal asphyxia (umbilical artery pH (<7.00)) and need for NICU admission. A full list of patient and obstetric characteristics as secondary outcomes is summarized in Tables 11.S1 and 11.S2. In the context of this study, we extracted the following information from the pathological reports: patient age at time of hysterectomy, year of hysterectomy, and previous diagnosis of endometriosis. Data Sources: PALGA – Dutch nationwide pathology databank The PALGA (Pathologisch Anatomisch Landelijk Geautomiseerd Archief, Houten, the Netherlands) database has existed since 1971, functioning as a data- and biobank for histopathological material collected from Dutch pathology laboratories. Since 1991, it has achieved national coverage and currently holds the data of approximately 12 million patients. All women who received a diagnosis of adenomyosis based on histopathology were collected from this database. These women were selected by conducting a systematic search, with support from a pathologist. See Appendix 11B for the search strategy used. Perined – Dutch National Perinatal Database Perined (Utrecht, the Netherlands) is the Dutch national perinatal database which records pregnancy outcomes of all women giving birth under
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