P39.09: Severe adenomyosis requiring cesarean hysterectomy

To present sonographic findings in a woman with cervical insufficiency and severe adenomyosis. She developed severe preeclampsia and fetal growth restriction necessitating cesarean delivery at 27 weeks gestation and hysterectomy. A 37-year-old gravida 7, para 0-0-6-0 with a history of multiple early and late first trimester losses conceived spontaneously. She had a past history of open myomectomy, uterine septum resection, and adenomyosis. At 8 weeks gestation, she experienced bleeding and an ultrasound revealed a 4.9 × 2.1 cm subchorionic hemorrhage. The uterus measured 18 × 13 × 18 cm and the anterior uterine wall was greater than 8 cm in diameter with a vascular, heterogeneous appearance consistent with adenomyosis. At 22 weeks gestation, cervical ultrasound demonstrated funneling and cervical shortening and examination confirmed dilation with visible membranes at the cervical os. She elected a rescue cerclage which was successfully placed. At 27 weeks gestation, she developed severe preeclampsia with fetal growth restriction (< 5%th percentile) and reversal of umbilical artery end diastolic flow (Figure 1). Fetal monitoring demonstrated recurrent fetal heart rate decelerations and a classical cesarean delivery was performed. She sustained significant uterine hemorrhage. Because of the severe adenomyosis, the uterine incision was unable to be reapproximated and hysterectomy was performed. The uterine pathology confirmed adenomyosis with a uterine weight of 2422 grams and a 2.5 cm uterine leiomyoma. The placental evaluation showed multiple small infarcts. This case demonstrates the antenatal ultrasonographic characteristics of severe adenomyosis and the potential maternal and neonatal morbidity associated with this condition during pregnancy. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.