Diagnosis of adenomyosis
The diagnosis of adenomyosis was based on transvaginal ultrasound and/or magnetic resonance imaging (MRI) performed before conception and/or during the first or second trimester of pregnancy. On transvaginal ultrasound, adenomyosis was diagnosed based on the Morphological Uterus Sonographic Assessment (MUSA) criteria established in 2019: asymmetrical thickening, cysts, hyperechoic islands, fan-shaped shadowing, echogenic subendometrial lines and buds, translesional vascularity, irregular junctional zone, and interrupted junctional zone.(16) On MRI, adenomyosis was diagnosed when one of the following two diagnostic criteria were met: 1) presence of a myometrial mass with indistinct margins with primarily low signal intensity, or 2) diffuse or focal thickening of the junctional zone forming an ill-defined area of low signal intensity on T2-weighted images.(17)