ScholarWorks@성균관대학교

초록

Objective: The aim of this study was to collect cases of uterine rupture and severe placenta accreta spectrum that occurred during pregnancy in women with prior adenomyomectomy or high-intensity focused ultrasound (HIFU) in women with adenomyosis in Korea and to conduct a clinical review to analyze the prognosis and risk factors. Methods: We collected nationwide cases of uterine rupture and severe placenta accreta spectrum during pregnancy following adenomyomectomy or HIFU in women with adenomyosis through an email survey conducted with members of the Korean Society of Maternal-Fetal Medicine. Retrospective chart reviews were performed to analyze clinical characteristics and pregnancy outcomes. Results: A total of 19 cases were collected from 9 institutions, comprising 16 cases with uterine rupture with or without placenta percreta and 3 cases with placenta percreta without uterine rupture. The gestational age at rupture ranged from the first trimester to the third trimester, with a median gestational age at 28 weeks. The interval between surgery and pregnancy ranged from 3 months to 60 months. The overall prognosis was very poor, with 13 fetal or neonatal deaths, 1 cerebral palsy, and 1 maternal death among 19 cases. Conclusion: Adenomyomectomy should be carefully considered for women of childbearing age with adenomyosis. Sufficient information regarding the risks of uterine rupture and placenta accreta spectrum during future pregnancy should be provided, and informed consent must be obtained prior to surgery.

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