使用盆腔超声检查评估妊娠期深部子宫内膜异位症和卵巢子宫内膜异位症的形态学外观。这是一项在伦敦大学学院医院进行了超过 3 年的前瞻性观察队列研究，该医院是治疗早期妊娠并发症和经认可的子宫内膜异位症的三级转诊单位中心。所有参与的女性都提供了书面同意，并被邀请在怀孕期间进行常规扫描时进行超声监测检查。所有扫描均由一名操作员执行，以消除观察者间的差异。卵巢子宫内膜异位瘤和结节的大小变化被报告为其平均直径的变化。具有不规则厚内壁、高回声乳头状突起和/或高血管分布的卵巢子宫内膜异位瘤以及具有中度至高血管分布的高回声结节被报告为蜕膜化。 65 名具有正常妊娠部位的活体妊娠且伴有深部和/或卵巢超声特征的女性子宫内膜异位症被纳入该研究。研究人群的中位年龄为 34 岁（范围，23-44）岁，就诊时的中位孕龄为 7  6（范围，3  6 至 18  0）周。在该队列中，47/65 (72%) 的人未生育过，48/65 (74%) 的人之前诊断过子宫内膜异位症，19/65 (29%) 的人通过体外受精受孕。有 10/65 (15% (95%CI, 7-24%)) 女性仅患有卵巢子宫内膜异位瘤，28/65 (43% (95%CI, 31-55%)) 女性仅患有子宫内膜异位结节，其余 27 名女性仅患有子宫内膜异位结节。 /65 (42% (95%CI, 30-54%)) 两者都有。在接受随访的卵巢子宫内膜异位症女性中，29/34 (85% (95% CI, 73-97%)) 经历了囊肿消退，2/34 (6% (95% CI, 0-14%)) 经历了囊肿消退。经历了囊肿生长，并且在 3/34 (9% (95%CI, 0.0-18%)) 的女性中，囊肿大小没有变化。 10/34（29%（95%CI，14-45%））所有囊肿完全消退。在接受随访的患有结节的女性中，43/51 (84% (95% CI, 74-94%)) 经历了结节消退，2/51 (4% (95% CI, 0-9%)) 经历了结节消退。结节生长，并且在 6/51 (12% (95%CI, 3-21%)) 的女性中，结节大小没有变化。在 4/51（8%（95%CI，0-15%））女性中，所有结节完全消退。在参加产后随访的 5/37（14%（95% CI，3-25%））女性中，所有子宫内膜异位病变在怀孕期间完全消退。在 10/34 (29% (95%CI, 14-45%)) 患有卵巢子宫内膜异位症的女性和 27/51 (53% (95%CI, 39-67%)) 患有结节的女性中，观察到了生长模式在妊娠早期和中期，随后在妊娠后期消退。在 17/34 (50% (95%CI, 33-67%)) 患有卵巢子宫内膜异位症的女性中观察到蜕膜化特征，最常见于妊娠早期，25/51 (49% (95%CI, 35-67%) 女性中观察到蜕膜化特征。 63%)) 患有结节的女性，最常见于妊娠中期。对于大多数女性来说，尽管蜕膜化的特征在妊娠早期和中期很常见，但卵巢子宫内膜异位瘤和深部结节会在怀孕期间消退。妊娠期子宫内膜异位症的形态变化很难与恶性病变的特征相鉴别。更好地了解妊娠期子宫内膜异位症的表现对于最大限度地减少干预并帮助为女性提供有关其病情的建议至关重要。 © 2023 作者。产科超声

To assess the morphological appearance of deep endometriosis and ovarian endometrioma in pregnancy using pelvic ultrasound examination.This was a prospective observational cohort study conducted over 3 years at University College London Hospital, which is a tertiary level referral unit for early pregnancy complications and an accredited endometriosis center. All women who participated provided written consent and were invited for surveillance ultrasound examination at the time of their routine scans in pregnancy. All scans were performed by a single operator to eliminate interobserver variability. The change in size of ovarian endometrioma and nodules was reported as change in their mean diameter. Ovarian endometrioma with irregular thick inner walls, hyperechoic papillary projections and/or high vascularity and hyperechoic nodules with moderate to high vascularity were reported as decidualized.Sixty-five women with a live, normally sited pregnancy and concomitant ultrasound features of deep and/or ovarian endometriosis were included in the study. The median age of the study population was 34 (range, 23-44) years, and the median gestational age at presentation was 7 + 6 (range, 3 + 6 to 18 + 0) weeks. From the cohort, 47/65 (72%) were nulliparous, 48/65 (74%) had a previous diagnosis of endometriosis and 19/65 (29%) conceived via in-vitro fertilization. There were 10/65 (15% (95% CI, 7-24%)) women with ovarian endometrioma alone, 28/65 (43% (95% CI, 31-55%)) with endometriotic nodules alone and the remaining 27/65 (42% (95% CI, 30-54%)) had both. Of the women with ovarian endometrioma who underwent follow-up, 29/34 (85% (95% CI, 73-97%)) experienced cyst regression, 2/34 (6% (95% CI, 0-14%)) experienced cyst growth, and in 3/34 (9% (95% CI, 0.0-18%)) women, cyst size was unchanged. In 10/34 (29% (95% CI, 14-45%)), there was complete resolution of all cysts. Of the women with nodules who underwent follow-up, 43/51 (84% (95% CI, 74-94%)) experienced nodule regression, 2/51 (4% (95% CI, 0-9%)) experienced nodule growth and, in 6/51 (12% (95% CI, 3-21%)) women, nodule size was unchanged. In 4/51 (8% (95% CI, 0-15%)) women, there was complete resolution of all nodules. In 5/37 (14% (95% CI, 3-25%)) women who attended postnatal follow-up, complete resolution of all endometriotic lesions occurred during pregnancy. In 10/34 (29% (95% CI, 14-45%)) women with ovarian endometrioma and 27/51 (53% (95% CI, 39-67%)) women with nodules, a pattern of growth was observed in the first and second trimesters, followed by regression later in pregnancy. Features of decidualization were observed in 17/34 (50% (95% CI, 33-67%)) women with ovarian endometrioma, most commonly in the first trimester, and in 25/51 (49% (95% CI, 35-63%)) women with nodules, most commonly in the second trimester.For the majority of women, despite features of decidualization being common in the first and second trimesters, ovarian endometrioma and deep nodules regress during pregnancy. Morphological changes of endometriosis in pregnancy are difficult to differentiate from characteristics of malignant lesions. Better understanding of the appearance of endometriosis in pregnancy is vital to minimize intervention and help counsel women regarding their condition. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.© 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.