Objective: To elucidate the incidence, risk factors, and clinical characteristics of uterine torsion in pregnancies complicated by adenomyosis, which remains unstudied to date. Design: Retrospective cohort study. Setting: University Hospital Tertiary Perinatal Centre Population: Pregnant women with adenomyosis who underwent caesarean section at our institution. Methods: Adenomyosis was diagnosed via magnetic resonance imaging and/or transvaginal ultrasonography before and/or during early pregnancy. Uterine torsion was defined as >45° rotation around the uterine long axis during a caesarean section. We compared the clinical characteristics, adenomyotic features (extent, location, and size), and surgical details of women with and without uterine torsion. Main Outcome Measures: Incidence of uterine torsion, its association with adenomyosis lesion characteristics, and its impact on surgical procedures. Results: Uterine torsion was identified in 6 of 70 women (8.6%) with adenomyosis, all asymptomatic. All torsion cases involved focal-type adenomyosis, representing 13.6% (6/44) of such cases. The torsion group required significantly more supraumbilical skin incisions (50.0% [3/6] vs. 0% [0/64], P<0.001) and atypical uterine incisions (83.3% [5/6] vs. 23.4% [15/64], P=0.0062) compared to the non-torsion group. Conclusions: Asymptomatic uterine torsion has a notably high incidence (8.6%) in pregnant women with adenomyosis undergoing caesarean section, with focal-type adenomyosis emerging as a potential key risk factor. Torsion significantly complicates caesarean delivery, often necessitating non-standard surgical approaches. Consequently, in pregnancies complicated by adenomyosis, preoperative assessments and intraoperative strategies that take uterine torsion into account are crucial.

Objective To clarify the clinical characteristics of pain developing in adenomyosis lesions during pregnancy and the perinatal outcomes associated with this phenomenon. Study Design Retrospective cohort study. Setting A tertiary hospital in Japan. Patients and methods Ninety one singleton pregnancies with adenomyosis who delivered between 2011 and 2021 were retrospectively analyzed. Pain during pregnancy was defined as persistent pain at the adenomyosis site with analgesics administration, and its association with perinatal outcomes was analyzed. Main outcome measures Pain at the adenomyosis lesion and its onset and duration, maximum C-reactive protein level during pain, and perinatal outcomes such as preterm delivery, preeclampsia, and blood loss. Results Among 91 singleton pregnancies with adenomyosis, 12 pregnancies (13.2%) presented with pain at the adenomyosis site. In total, 5 of the 12 pregnancies (41.7%) developed preeclampsia, which resulted in preterm delivery. The incidence of preeclampsia and preterm delivery was higher in those who experienced pain than in those without (41.7% vs. 13.9%; p<0.05, and 66.7% vs. 31.7%; p<0.05, respectively). Among women with pain during pregnancy, the maximum C-reactive protein level was significantly higher in women who developed preeclampsia than in those without (5.45 vs. 0.12 mg/dL, p<0.05). Conclusion Adenomyosis can cause pain in over one of eight pregnancies with adenomyosis, which may be associated with the increased incidence of preeclampsia resulting in preterm delivery. Women with pain at the adenomyosis lesion, especially those with high C-reactive protein levels, may be at high risk for the future development of preeclampsia.

We encountered a case in which a recurrent condyloma-like papillary tumor was repeatedly treated as condyloma. Therefore, the patient was re-diagnosed and treated for non-invasive cervical papillary squamous cancer (PSCC) with HPV6 infection. To the best of our knowledge, this is the first report of HPV6 infection in PSCC.