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.