Beyond infertility: obstetrical and postpartum complications associated with endometriosis and adenomyosis

Abstract

The risk of pregnancy and neonatal complications in women with endometriosis and adenomyosis is debatable. A literature review looking at rates, presentation, and management of spontaneous hemoperitoneum, enlargement, abscess, and rupture of an endometrioma, uterine rupture, and bowel perforation in pregnant women with endometriosis was conducted. Moreover, studies addressing differences in early pregnancy (miscarriage), late pregnancy (gestational diabetes mellitus, preeclampsia, prematurity, placenta previa, placental abruption, cesarean section, hemorrhages) and neonatal outcomes (weight at birth) between endometriosis and adenomyosis patients versus control subjects were reviewed. The overall prevalence of endometriosis-related spontaneous hemoperitoneum in pregnancy is estimated to be ∼0.4%. Only four cases of endometrioma rupture in pregnancy have been reported. Although during pregnancy there is no way to anticipate the onset of complications from preexisting endometriosis, it is important, when a specific abdominal pain occurs, to suspect rare but potentially life-threating events. Population-based studies suggest a possible association of endometriosis with preterm birth and placenta previa. Limits of the published studies are noted and discussed.

Hemoperitoneum Following Sexual Intercourse in a Woman with Deep Infiltrating Endometriosis

“…As recently reported in a systematic review by Viganò et al [3,] endometriosis represent a major risk factor for spontaneous hemoperitoneum in pregnancy, with an overall prevalence of this complication of 0.4%. However, only few cases of non-gravid women with endometriosis and spontaneous hemoperitoneum have been previously described [6,7,8,9,10,11,12,13,14] (table 1).…”

“…In addition, hemothorax represents a possible associated atypical sign [3]. Imaging techniques for the diagnosis of spontaneous hemoperitoneum comprehend ultrasonography and, secondly, CT.…”

“…A rare and life-threatening complication associated with endometriosis is represented by spontaneous hemoperitoneum; most of the cases previously reported in the literature described events of spontaneous hemoperitoneum in pregnant women with endometriosis [2,3,4]. Spontaneous hemoperitoneum typically presents with signs of acute intraperitoneal bleeding and occasionally abdominal compartment syndrome in severe cases [5].…”

Kinderwunsch und Schwangerschaft bei Endometriose

“…Im Hinblick auf Geburtsgewicht und SGA-Häufigkeit konnte kein Unterschied zwischen den Gruppen festgestellt werden[31]. Das Vorhandensein einer Adenomyosis uteri wurde in der Literatur ebenso mit einem höheren Frühgeburts-risiko assoziiert[32].Diese Komplikation ist selten. In einer systematischen Übersichtsarbeit konnten dennoch 21 Fälle erhoben werden[24].…”

“…In einer systematischen Übersichtsarbeit konnten dennoch 21 Fälle erhoben werden[24]. Die Ruptur von Endometriomen während einer Schwangerschaft ist ein ebenso selten berichtetes Ereignis[32]. Dennoch muss eine dokumentierte Aufklärung über diese Risiken stattfinden, wenn eine Patientin bezüglich der Entscheidung beraten wird, eine Endometriosesanierung durchzuführen oder direkt einen IVF/ ICSI-Versuch zu unternehmen.Eine norwegische Studie hat kürzlich ergeben, dass jeder vierte Patient unter Opioid-Langzeittherapie an der Medikation hängen bleibt.…”