Cesarean Section with Adenomyomectomy: Bridging Obstetric Delivery and Reconstructive Uterine Surgery

Abstract Massive uterine adenomyosis has traditionally been regarded as incompatible with fertility, particularly when pregnancy advances to term. Conventional treatments have focused on symptom control or hysterectomy, often at the expense of reproductive potential. Although cesarean adenomyomectomy has been described in select centers, its use in extensive adenomyosis remains rare, technically demanding, and insufficiently studied. This review synthesizes available clinical reports and case series in which cesarean adenomyomectomy was performed during delivery in patients with diffuse or massive adenomyosis. The discussion highlights surgical techniques, perioperative management strategies, patient selection criteria, and maternal–fetal outcomes. Particular attention is given to intraoperative myometrial resection and multilayered uterine reconstruction, focusing on the dual goals of maternal safety and fertility preservation. The evidence, though limited, suggests that with appropriate expertise and planning, cesarean adenomyomectomy can result in live births while conserving uterine integrity. Maternal outcomes have generally been favorable, with controlled blood loss, uneventful postoperative recovery, and no reported intraoperative uterine rupture or hysterectomy in the reviewed cases. Neonatal outcomes have also been encouraging, with most infants delivered in good condition. Importantly, follow-up data reveal that some patients achieved subsequent spontaneous pregnancies and successful deliveries. These findings challenge the prevailing view that massive adenomyosis precludes both safe delivery and future fertility. As the number of reported cases grows, this approach warrants further evaluation through standardized protocols, multicenter data collection, and the development of ethical frameworks to guide clinical decision-making. Cesarean adenomyomectomy may therefore represent a viable, fertility-preserving option in carefully selected patients.