Abstract :Background: Adenomyosis occurs when endometrial tissue is found within the myometrium. The
risks of adenomyosis in pregnancy are well described and include preterm delivery and preterm
premature rupture of membranes, however only a few case reports describe the risks of delivery in
the setting of extensive adenomyosis.
Case Presentation: We report the case of a 36-year-old G2P0010 at 38 week and 4 days gestation
who presented in labor. The fetus was in the breech presentation so she underwent a primary
Cesarean section. At the time of surgery, extensive transmural adenomyosis with decidualization
was noted, ultimately requiring a Cesarean hysterectomy due to intra-operative hemorrhage.
Conclusion: This case emphasizes the importance of early clinical suspicion of adenomyosis in
pregnancy to mitigate potentially life-threatening hemorrhage.