Minerva obstetrics and gynecology最新文献

{"title":"The development of the first public Italian preimplantation genetic testing network.","authors":"Alessandro Conforti, Chiara Faggionato, Vincenzo Vigiliano, Claudia Cartolano, Daniela Zuccarello, Federica Cariati, Jessica Parrotta, Giulia Scaravelli, Simone Bolli, Leonardo Salviati, Roberta Venturella, Carlo Alviggi","doi":"10.23736/S2724-606X.26.05956-7","DOIUrl":"https://doi.org/10.23736/S2724-606X.26.05956-7","url":null,"abstract":"","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum anti-Müllerian hormone does not predict adverse perinatal outcomes in a cohort of women diagnosed with recurrent pregnancy loss.","authors":"Maria Longo, Serena Lecis, Gloria Guariglia, Chiara Selmi, Francesca Baschieri, Riccardo Cuoghi Costantini, Sara Lazzarin, Isabella Neri, Antonio LA Marca, Francesca Monari","doi":"10.23736/S2724-606X.26.05887-2","DOIUrl":"10.23736/S2724-606X.26.05887-2","url":null,"abstract":"<p><strong>Background: </strong>The predictive value of serum Anti-Müllerian Hormone (AMH) for overall reproductive potential remains controversial, particularly with respect to obstetric and perinatal outcomes. The aim of this study was to evaluate the association between AMH levels and adverse maternal and neonatal outcomes in a large cohort of women diagnosed with recurrent pregnancy loss (RPL).</p><p><strong>Methods: </strong>This retrospective observational cohort monocentric study included women assessed for RPL at a tertiary referral center between 2014 and 2023. Patients were stratified according to serum AMH levels (<0.7 vs. ≥0.7 ng/mL). Pregnancy and perinatal outcomes were evaluated using composite adverse neonatal outcomes (CANO), including birth weight <2500 g, neonatal intensive care unit admission, 5-minute Apgar score <7, birth weight below the 10^th percentile, stillbirth and perinatal death. Composite adverse maternal outcomes (CAMO) included emergency cesarean section, operative vaginal delivery, postpartum hemorrhage, and intensive care unit admission. Descriptive and inferential statistical analyses were performed. Logistic regression models were used to investigate factors associated with adverse maternal and neonatal outcomes.</p><p><strong>Results: </strong>During the study period, 453 women were evaluated for RPL. Serum AMH levels were available for 281 women (62.0%), and pregnancy outcome data were available for 123 women (44.1%). Among these, 11 women (8.7%) experienced a miscarriage, while 112 (90.3%) achieved a live birth. Women with AMH <0.7 ng/mL (N.=60; 13.25%) were significantly older (P<0.001), had a higher number of previous miscarriages (P=0.03), and a higher prevalence of hereditary thrombophilia (P=0.005). Among ongoing pregnancies, women with low AMH showed a higher prevalence of thyroid disorders (P=0.025) and lower antral follicle count (P=0.016). Multivariable analysis demonstrated no significant association between AMH levels and composite adverse neonatal or maternal outcomes, while labor induction was independently associated with a reduced risk of adverse neonatal outcomes.</p><p><strong>Conclusions: </strong>In women with recurrent pregnancy loss, low AMH levels were not associated with an increased risk of adverse maternal or neonatal outcomes. Labor induction appeared to exert a protective effect on neonatal outcomes. Prospective studies are warranted to confirm these findings and to support periconceptional counseling in this population.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"421-428"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prophylactic ureteral suturing after ureterolysis in deep endometriosis: description of a conservative laparoscopic technique.","authors":"Carlo De Cicco Nardone, Maria Cristina Sangiovanni, Francesco Plotti, Roberto Montera, Roberto Angioli, Corrado Terranova","doi":"10.23736/S2724-606X.25.05847-6","DOIUrl":"10.23736/S2724-606X.25.05847-6","url":null,"abstract":"<p><strong>Background: </strong>To describe a novel laparoscopic technique, prophylactic ureteral suturing (PUS), developed to reinforce structurally weakened ureteral segments following extensive ureterolysis for deep endometriosis, to avoid segmental resection or reimplantation.</p><p><strong>Methods: </strong>In selected patients with deep ureteral endometriosis, circumferential periureteral fibrosis was dissected after cystoscopic insertion of a double-J ureteral stent. Laparoscopic ureterolysis restored ureteral mobility and revealed a mucosa-only segment, considered at high risk of postoperative stricture or rupture, resulting from complete loss of the muscularis layer. The muscularis layers proximal and distal to the mucosal tract were then gently mobilized and reapproximated using interrupted absorbable 3-0 polyglactin sutures, avoiding mucosal penetration. This suture-based reconstruction restored circumferential wall support while maintaining luminal patency.</p><p><strong>Results: </strong>An observational study was conducted on a cohort of 6 patients using the novel technique. No intraoperative or postoperative complications were observed. Renal function was preserved in all cases. Among three patients with preoperative hydronephrosis and elevated creatinine, imaging confirmed resolution of obstruction and normalization of renal parameters at follow-up.</p><p><strong>Conclusions: </strong>Prophylactic ureteral suturing may represent a safe and effective conservative alternative to reconstructive procedures in cases of ureteral muscularis loss during ureterolysis. The approach is technically straightforward, preserves ureteral continuity and the native antireflux mechanism, and can be integrated into standard laparoscopic treatment of urinary tract endometriosis. Further studies are warranted to confirm its long-term safety and broader applicability.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"402-410"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fertility in adenomyosis: surgery or IVF?","authors":"Sutan Chandra, Dian Tjahyadi, Anita Rachmawati, Hanom H Syam","doi":"10.23736/S2724-606X.26.05874-4","DOIUrl":"10.23736/S2724-606X.26.05874-4","url":null,"abstract":"<p><p>Adenomyosis is a chronic reproductive condition that impairs fertility and is characterized by endometrial tissue invading the myometrium. Despite advances in MRI and 3D ultrasound for diagnosis, there is still no consensus on optimal fertility management. The choice between uterus-sparing surgery and direct IVF, including the ideal timing for each approach, remains a subject of ongoing debate. This narrative review analyzed relevant studies retrieved from PubMed, Scopus, and Web of Science, focusing on uterine morphology, hormonal and surgical therapeutic responses, and IVF/ICSI outcomes in women with adenomyosis. Infertility in adenomyosis is associated with JZ remodeling, inflammation, hypercontractility, and impaired endometrial receptivity. Poor prognostic markers include JZ thickness ≥8.5 mm, uterine volume 90-130 mL, and MUSA direct features. These features are linked to lower live birth rates (aRR=0.62; 95% CI 0.43-0.88; P=0.007) and higher miscarriage risk (aRR=2.88; 95% CI 1.49-5.57; P=0.002), with larger uterine volume (>130 cm³) and thicker JZ significantly correlating with pregnancy failure and reduced cumulative live birth in Kaplan-Meier analyses. Assessment of JZ morphology, uterine volume, and MUSA features is crucial for individualized treatment planning in women with adenomyosis and infertility. Based on observational data, a pragmatic approach may include: 1) medical therapy with GnRH agonists for 3-6 cycles for uterine volumes 100-200 mL and JZmax 8.5-16 mm, followed by IVF; 2) consideration of uterus-sparing surgery for volumes >200 mL and JZmax >16 mm in highly selected patients, then IVF with an ultra-long protocol; and 3) direct IVF for volumes <100 mL and JZmax <8.5 mm, preferably using an ultra-long protocol with a freeze-all and HRT-FET strategy. These proposals are intended as a clinically oriented framework derived from current observational evidence rather than as formal guideline recommendations.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"437-453"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148277897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaginal natural orifice transluminal endoscopic myomectomy.","authors":"Alexandros Fanourgiakis, Alexandros Lazaridis, Jan Baekelandt, Christos Damaskos, Nikolaos Garmpis, Dimitrios Dimitroulis, Nikos F Vlahos","doi":"10.23736/S2724-606X.26.05932-4","DOIUrl":"10.23736/S2724-606X.26.05932-4","url":null,"abstract":"<p><strong>Background: </strong>Vaginal natural orifice transluminal endoscopic surgery (vNOTES) avoids abdominal incisions and is increasingly used for benign gynecologic surgery, but evidence for fertility-sparing myomectomy remains limited.</p><p><strong>Methods: </strong>We searched PubMed, MEDLINE, EMBASE and Scopus (January 1, 2000 - July 31, 2025) for comparative studies (vNOTES vs. multi-port or laparoendoscopic single-site [LESS] myomectomy) and single-arm vNOTES cohorts. Two reviewers screened/extracted data. Risk of bias was assessed using Newcastle-Ottawa (comparative) and Joanna Briggs Institute (JBI; case series). Random-effects meta-analysis (inverse-variance) was performed when mean ± standard deviation (SD) were available; heterogeneity was assessed with I².</p><p><strong>Results: </strong>Seven studies were included (three comparative; four single-arm), totaling 348 vNOTES and 272 laparoscopic cases. Three cohorts contributed to the meta-analysis of vNOTES versus LESS for operative time, blood loss, length of stay, time to first flatus, and conversion; two cohorts contributed to infection pooling. There was no clear difference in operative time (mean differences [MD] -2.2 min, 95% confidence interval [CI] -10.8 to 6.4) or blood loss (MD -1.9 mL, 95% CI -20.2 to 16.5). vNOTES was associated with earlier first flatus (MD -7.4 h, 95% CI -9.7 to -5.1). Length of stay was shorter but highly heterogeneous and imprecise (MD -0.95 days, 95% CI -2.28 to 0.38; I²=96%). Postoperative infection estimates favored LESS in two cohorts (RR 6.00, 95% CI 1.10 to 32.63). Conversion was uncommon but occurred only in vNOTES arms (RR 5.01, 95% CI 0.89 to 28.15). Across all vNOTES cohorts, rectal injury occurred in 4/348 (1.15%).</p><p><strong>Conclusions: </strong>In highly selected patients treated in expert centres, vNOTES myomectomy appears feasible, with low-certainty evidence suggesting earlier bowel recovery versus LESS. However, the available comparative evidence is event-sparse and observational; reported rectal injuries and vaginal/cuff infections should be interpreted as hypothesis-generating safety signals rather than definitive comparative risks. Generalizability and long-term reproductive outcomes remain uncertain, as there is need for more robust evidence from comparative studies.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":"78 5","pages":"454-472"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is screening for domestic violence routinely performed during pregnancy? Insights from women delivering in a referral hospital in Northern Italy.","authors":"Michela Molgora, Laila G Micci, Lucia M Ghezzi, Gabriele Rossi, Maddalena Tosi, Marco Reschini, Irene Cetin, Edgardo Somigliana, Giussy Barbara","doi":"10.23736/S2724-606X.26.05895-1","DOIUrl":"10.23736/S2724-606X.26.05895-1","url":null,"abstract":"<p><strong>Background: </strong>Pregnancy is a vulnerable period for intimate partner violence, as violence may emerge or intensify. On this basis, several international guidelines recommend systematic and repetitive screening of domestic violence during pregnancy. However, the adherence to these recommendations is unclear.</p><p><strong>Methods: </strong>This prospective observational study involved women who delivered in an urban referral obstetrical hospital located in Milan, Northern Italy. Participants were enrolled after delivery and completed an anonymous questionnaire structured into four sections: demographic characteristics, pregnancy-related information, assessment of whether domestic violence screening was performed during gestation, and evaluation of any recent history of abuse. This latter issue was investigated through four different validated questionnaires.</p><p><strong>Results: </strong>Among the 196 participants, nine (4.6%, 95%CI: 2.4-8.5%) reported having been screened at least once during pregnancy about a history of domestic violence. Some differences emerged according to the setting of antenatal care. The frequency of a history of abuses in the studied cohort differed according to the questionnaire used but was not rare, prevalences varying between 1.0% to 5.6%.</p><p><strong>Conclusions: </strong>Screening for intimate partner violence in pregnancy is seldom performed. A call for action is warranted.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"429-436"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148211793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applying machine-learning models to successful vaginal birth after two cesareans.","authors":"Rachel S Griffin, Emanuelle Hay, Itai Braude, Nir R Duvdevani, Ron Rosenberg, Yael Yekel, Amir Weintraub, Yael Pasternak","doi":"10.23736/S2724-606X.26.05875-6","DOIUrl":"10.23736/S2724-606X.26.05875-6","url":null,"abstract":"<p><strong>Background: </strong>Vaginal birth after two cesarean deliveries (VBAC2) is increasingly recognized as a reasonable and, in selected cases, preferable option. Current evidence suggests that successful and safe VBAC2 can be achieved, particularly among carefully selected candidates, including grand multiparous women. However, the factors that reliably predict success and reduce maternal and neonatal risk in this population remain insufficiently defined.</p><p><strong>Methods: </strong>This retrospective observational study included 541 women with a history of two previous cesarean deliveries who attempted vaginal birth between 2005 and 2022 at a single tertiary teaching hospital. Machine learning models were applied to predict the safety and success of VBAC2 using maternal demographic and clinical characteristics. The primary outcome was successful VBAC2 without uterine rupture. Secondary outcomes included low Apgar score, admission to the Neonatal Intensive Care Unit (NICU), and the need for postpartum blood transfusion.</p><p><strong>Results: </strong>A total of 541 women attempted a trial of labor, and 78.9% achieved a successful VBAC. Uterine rupture occurred in 2.0%. The XGBoost Classifier performed best with a sensitivity of 83%. The most important factors associated with successful VBAC were the time interval since the last cesarean delivery, followed by the number of previous vaginal births and cervical dilatation at admission.</p><p><strong>Conclusions: </strong>Grand multiparous women had significantly higher VBAC2 success rates, while uterine rupture rates remained low. Machine learning models can help predict the likelihood of safe vaginal delivery after two cesarean deliveries, thereby supporting informed decision-making regarding the preferred mode of delivery in this unique population. Predictive modeling in this study showed that grand multiparous women had high VBAC2 success rates (78.9%) with a low risk of uterine rupture (2%); key predictors included prior vaginal birth and cervical dilatation.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"411-420"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148218416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating embryo euploidy among patients diagnosed with inflammatory bowel disease undergoing in vitro fertilization.","authors":"Atoosa Ghofranian, Samantha L Estevez, Diana S Shaari, Tamar Alkon-Meadows, Carlos Hernandez-Nieto, Morgan Baird, Joseph A Lee, Alan B Copperman, Jenna Friedenthal","doi":"10.23736/S2724-606X.26.05871-9","DOIUrl":"https://doi.org/10.23736/S2724-606X.26.05871-9","url":null,"abstract":"<p><strong>Background: </strong>The impact of inflammatory bowel disease (IBD) on embryo chromosomal competence during in vitro fertilization (IVF) remains poorly defined. This study aimed to evaluate embryo euploidy rates among patients with IBD undergoing IVF with preimplantation genetic testing for aneuploidy (PGT-A), compared with patients without IBD.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted at an urban, academic reproductive medicine center. A total of 43 patients with IBD (Crohn's disease or ulcerative colitis) and 129 matched controls without IBD who underwent IVF with PGT-A between 2011 and 2022 were included. Patients with endometriosis, severe male factor infertility, prior chemotherapy or radiation exposure, or chromosomal translocations were excluded. All patients underwent controlled ovarian hyperstimulation, oocyte retrieval, intracytoplasmic sperm injection, and trophectoderm biopsy with PGT-A using next-generation sequencing. The primary outcome was euploid blastocyst rate. Secondary outcomes included oocyte yield, oocyte maturity and fertilization rates, blastulation rate, and rates of aneuploid and mosaic embryos.</p><p><strong>Results: </strong>Euploid blastocyst rates were identical between patients with and without IBD (47.5% vs. 47.5%, P=0.99), with no significant differences in aneuploid or mosaic embryo rates. Patients with IBD had significantly higher total and mature oocyte yields despite comparable baseline ovarian reserve parameters. No differences were observed in oocyte maturity, fertilization, or blastulation rates. Results remained unchanged after multivariate adjustment.</p><p><strong>Conclusions: </strong>In this cohort, patients with IBD undergoing IVF with PGT-A had euploid blastocyst rates similar to those without IBD, suggesting no clear impact on embryo chromosomal competence. However, given the retrospective design and small sample size, these findings should be interpreted with caution, and a modest effect cannot be excluded. Overall, the results provide some clinical reassurance and support ART as a reasonable option for patients with IBD, while underscoring the need for prospective studies to further evaluate disease-related factors.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conversion rates from total robotic hysterectomy to laparotomy in gynecologic oncology surgery.","authors":"Peter Scalia, Shannon Salvador, Susie K Lau, Melica Brodeur, Gabriel Levin, Walter Gotlieb","doi":"10.23736/S2724-606X.26.05936-1","DOIUrl":"https://doi.org/10.23736/S2724-606X.26.05936-1","url":null,"abstract":"<p><p>The widespread adoption of the da Vinci robotic systems across medical centres has enabled gynecology oncologists to perform more complex gynecologic procedures by minimally invasive approaches, leading to improved patient outcomes. In this context, conversion - both planned and unplanned - from robotics to laparotomy represent a key metric. We conducted a narrative review to determine the conversion rate from robotic to laparotomy and synthesized the key reasons why conversions take place in gynecologic oncology procedures. A total of 27 retrospective/prospective studies were included in the review, with a total of 474/11,766 (4.0%) documented robotic cases with conversions. The most prominent reason for robotic conversion to laparotomy in gynecologic oncology was for the purpose of specimen removal due to uterine size (N.=105). Second, came the extent of disease (N.=74), and third were adhesions (N.=65). A clear association between conversion and Body Mass Index was gleaned from the data. Our narrative review shows a 4.0% conversion rate from robotic to laparotomy in complex gynecologic oncology procedures. Reasons relate to planned conversion as in the case of specimen removal, whereas a number of cases were related to upholding oncologic principles and avoid tumor spillage or adhesions.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound signs of adenomyosis in pregnancy and counselling related to infertility and obstetric outcomes.","authors":"Emma Bertucci, Sofia Ceffa, Alessandra Danieli, Marialaura Diamanti, Filomena G Sileo, Anna L Tramontano, Carlo Alboni, Antonio La Marca","doi":"10.23736/S2724-606X.25.05857-9","DOIUrl":"10.23736/S2724-606X.25.05857-9","url":null,"abstract":"<p><p>Adenomyosis is the presence of endometrial glands and stroma within the myometrial wall of the uterus. This condition is related to a diffusely enlarged uterus with reactive hyperplasia and fibrosis of the surrounding myometrial smooth muscle cells. The symptomatology of adenomyosis is highly heterogeneous among patients and there are no pathognomonic symptoms specific to the condition. Clinically, although approximately 30% of patients remain asymptomatic, it can manifest as abnormal bleeding, pelvic pain, infertility and adverse obstetric outcome: miscarriage, preterm labor, uterine atony, other complications during labor. Diagnosis of adenomyosis relies on imaging techniques such as transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI). Precise ultrasound diagnosis enables the identification of symptomatic patients and allows for the implementation of appropriate treatments based on the severity of adenomyosis-related symptoms. Treatment options include pharmacological treatments usually with progestin or levonorgestrel-releasing intrauterine systems, hysteroscopic resection or ablation, conservative surgical methods and high-intensity focused ultrasound (HIFU). Diagnosis of adenomyosis during pregnancy can present challenges, as its symptoms may overlap with those of pregnancy, and it may be difficult to diagnose or differentiate from other conditions that affect the uterus during pregnancy. Additionally, imaging techniques commonly used to diagnose adenomyosis, such as transvaginal ultrasound and MRI, must be used cautiously due to the changes that occur in the uterus during pregnancy. Pregnancy leads to significant changes in the size and shape of the uterus, which can make the typical features of adenomyosis less apparent on imaging studies. Several studies suggest that adenomyosis may be linked to \"unexplained infertility\" and it is also conceived as a reproductive disorder, with reported prevalence rates of 38.2% in cases of recurrent pregnancy loss. Given the emerging evidence about the negative impact of adenomyosis on fertility and obstetric outcomes, accurate pre-conception and post-conception counseling is crucial. Treatment during pregnancy is generally conservative and they are based on symptoms control causing significant discomfort or interfere with pregnancy, management may include pain relief, such as acetaminophen or, in some cases, opioids (with caution) and careful monitoring throughout pregnancy. If adenomyosis is suspected during pregnancy, the condition is usually addressed post-delivery, and the approach to treatment depends on the severity of symptoms and any pregnancy complications that may arise. The aim of this review is to provide preconception and post-conception counselling for patients with adenomyosis, focusing on its impact on fertility and obstetric outcomes. It also aims to offer information on the symptoms and ultrasound diagnosis during pregnancy to ensure careful monitoring.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"375-387"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147486537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}