Practical and clinical recommendations
Our findings suggest that adenomyosis can trigger abdominal pain during
pregnancy, but as with fibroid degeneration, it is essential to rule out
other diseases when uterine tenderness and enhanced inflammation are
observed among pregnant women, especially threatened preterm labor with
IAI. In the case with prominent inflammation and severe pain at onset
(#3 in Table 1), IAI was initially suspected when the patient presented
with acute abdominal pain and an enhanced inflammatory response.
Therefore, we performed amniocentesis to rule out IAI, followed by MRI,
which showed hemorrhagic degeneration of the adenomyosis, as previously
reported.(11) In the other 11 cases, the patients had confined pain at
the adenomyosis site on primary presentation without shortening of the
cervix; therefore, we clinically diagnosed these patients with
adenomyosis pain. Moreover, all placentae from 15 pregnancies underwent
pathological examination, of which only two cases (#2 and #3 in Table
1) showed histological chorioamnionitis of stage 1 based on Blanc’s
classification(32) in the absence of any sign suggestive of clinical
IAI, which implies that the pain observed in 12 pregnancies is likely to
be distinct from IAI. Consequently, we believe that the diagnosis of
adenomyosis pain should be based on clinical symptoms by carefully
excluding IAI. Of note, even after the pain resolves and a decrease in
CRP level is confirmed, women with adenomyosis pain accompanied by
elevated CRP levels warrant close follow-up for the onset of PE as a
high-risk group of patients.