Pregnancy outcomes in patients with uterine junctional zone thickening

Hypothesis/aims of study. Overcoming infertility and miscarriage in adenomyosis is a complex practical problem in obstetrics and gynecology. It is likely that one of the signs of the disease is a thickening of the transitional zone between the endometrium and the myometrium (J-zone), which can be visualized using magnetic resonance imaging (MRI). The data on the influence of the biometric characteristics of the J-zone on the course and outcome of pregnancy in patients with adenomyosis is ambiguous. This study was aimed to assess the effect of J-zone thickness on pregnancy outcomes in patients with adenomyosis. Study design, materials and methods. This is a prospective study, which included 102 patients aged 22-39 years with ultrasound signs of adenomyosis who were going to conceive. The patients were divided into two groups: Group 1 (n = 58) consisted of nulliparous patients with no history of previous intrauterine interventions; Group 2 (n = 58) comprised multiparous women with any of those, such as curettage of the uterine cavity for a non-developing or unwanted pregnancy and separate diagnostic curettage for a reason not related to pregnancy. Using MRI, J-zone maximum thickness was measured at the thickest part. We evaluated the relationship between J-zone thickness and pregnancy outcomes, while estimating J-zone thresholds for subfertility outcomes in the both groups. Results. The average value of J-zone maximum thickness in Group 2 was significantly higher than that in Group 1 and amounted to 12.1 ± 4.2 mm and 10.3 ± 3.9 mm, respectively (p 0.05). The frequency of retrochorial hematoma was diagnosed in 13.8% and 22.7% of cases, respectively, and did not differ significantly in the both groups (p > 0.05). The frequency of spontaneous miscarriage in Group 1 and Group 2 did not differ, either (6.9% and 6.8%, p > 0.05). The J-zone thresholds for unfavorable pregnancy outcomes were determined with a probability of 60% in Group 1 (9.1 mm) and Group 2 (10.0 mm). Conclusion. J-zone thickness may be used as a prognostic marker of pregnancy outcome in patients with adenomyosis.

Full Text About the authors Ekaterina K. Orekhova The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott; МС Ltd Author for correspondence. Email: [email protected] MD, Post-Graduate Student (Applicant) Russian Federation, Saint PetersburgOlga A. Zhandarova City Mariinskaya Hospital Email: [email protected] ORCID iD: 0000-0002-7351-6900 SPIN-code: 6572-6450 MD Russian Federation, Saint PetersburgIgor Yu. Kogan The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott; Saint Petersburg State University Email: [email protected] ORCID iD: 0000-0002-7351-6900 SPIN-code: 6572-6450 MD, PhD, DSci (Medicine), Professor, Corresponding Member of RAS, Director; Professor. The Department of Obstetrics, Gynecology, and Reproductive Sciences, Medical Faculty Russian Federation, Saint PetersburgReferences - Harada T, Taniguchi F, Amano H, et al. 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