34 suggested that women with adenomyosis specifically have a higher risk of late-onset preeclampsia(4). Evidence also exists which introduces a correlation between adenomyosis and placental malposition (i.e. placenta praevia) and placental abruption (101,104,106,108). Adenomyosis and neonatal outcomes No studies thus far have been able to prove a significant association between adenomyosis and adverse neonatal outcomes (not including low birth weight, LBW). The few studies investigating outcomes such as low Apgar score or umbilical artery pH did not report significant results (50,105). Despite most the published studies reporting evidence to associate adenomyosis with obstetric complications there are a few common weaknesses to these studies which may limit their generalisability. First, they all have relatively small sample sizes, with the largest study including 245 women with adenomyosis (101), and most studies including 50-60. Furthermore, all studies used trans-vaginal ultrasound diagnosis (or 2 only self-reported diagnosis (101,110)) as the diagnostic method of choice for adenomyosis, which is not considered the golden standard of adenomyosis diagnosis. It can be argued therefore that one cannot be certain that the previously carried out studies truly included the correct population. In addition, no studies have thus far been conducted investigating this question in a Dutch population, with very few being carried out in a large (European) population in general. Further common issues with these studies are heterogenous inclusion/exclusion criteria, and presence of various confounding factors such as most studies only investigating fertility outcomes in IVF/ICSI patients. So, due to the scarce and still relatively conflicting evidence, women with adenomyosis are not generally considered to qualify as having high-risk pregnancies, and no guidelines exist for the management of pregnant women diagnosed with adenomyosis. More large-scale studies are needed to yield unambiguous results to inform clinical practice and management of these women.
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