Pregnancy outcomes in patients with uterine junctional zone thickening

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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 pregnancy rate in the both groups did not differ significantly and amounted to 43.1% in Group 1 and 38.6% in Group 2 (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.

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About the authors

Ekaterina K. Orekhova

The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott; МС Ltd

Author for correspondence.

Russian Federation, Saint Petersburg

MD, Post-Graduate Student (Applicant)

Olga A. Zhandarova

City Mariinskaya Hospital

ORCID iD: 0000-0002-7351-6900
SPIN-code: 6572-6450

Russian Federation, Saint Petersburg


Igor Yu. Kogan

The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott; Saint Petersburg State University

ORCID iD: 0000-0002-7351-6900
SPIN-code: 6572-6450

Russian Federation, Saint Petersburg

MD, PhD, DSci (Medicine), Professor, Corresponding Member of RAS, Director; Professor. The Department of Obstetrics, Gynecology, and Reproductive Sciences, Medical Faculty


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Supplementary files

Supplementary Files Action
Fig. 1. ROC curve prediction model for an adverse pregnancy outcome by the JZmax factor in patients with adenomyosis: а — Group I; b — Group II

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Fig. 2. Sagittal T2-weighted magnetic resonance image. Patient: a woman aged 27 years old, nullipara with no history of previous intrauterine interventions. J-zone maximum thickness was 13.4 mm

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Copyright (c) 2020 Orekhova E.K., Zhandarova O.A., Kogan I.Y.

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