Complications during pregnancy and delivery in women with untreated rectovaginal deep infiltrating endometriosis

Exacoustòs, C.; Lauriola, I.; Lazzeri, Lucia; Felice, G. De; Zupi, Errico

doi:10.1016/j.fertnstert.2016.06.024

Cited by 87 publications

(166 citation statements)

References 36 publications

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“…Compared with the latter patients, those with rectovaginal endometriosis had an almost six‐fold increase in risk (OR, 5.8; 95% CI, 1.5–22.0). An increased prevalence of placenta praevia in association with deep endometriotic lesions within the posterior pelvic compartment was also reported in a subsequent cohort [17.1% (7/41) in women with ≥2 cm nodules versus 0.3% (1/300) in women without a diagnosis of endometriosis (OR, 61.6; 95% CI, 7.4–515.5)] . One further series, however, did not find a difference between deep and more superficial endometriosis in the rate of placenta praevia .…”

Section: The Effect Of Severe Forms Of Endometriosis and Deep Lesionssupporting

confidence: 54%

“…One further series, however, did not find a difference between deep and more superficial endometriosis in the rate of placenta praevia . Several pathogenic hypotheses have been formulated regarding the mechanisms underlying a possible association between deep endometriosis and placenta praevia …”

Section: The Effect Of Severe Forms Of Endometriosis and Deep Lesionsmentioning

confidence: 98%

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The ominous association between severe endometriosis, in vitro fertilisation, and placenta previa: raising awareness, limiting risks, informing women

Vercellini

Frattaruolo

Barbara

et al. 2017

BJOG

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Please cite this paper as: Vercellini P, Frattaruolo MP, Barbara G, Buggio L, Somigliana E. The ominous association between severe endometriosis, in vitro fertilisation, and placenta previa: raising awareness, limiting risks, informing women. BJOG 2018;125:12-15. Endometriosis is associated with several adverse pregnancy outcomes.1 The most severe maternal complications are spontaneous haemoperitoneum in the second half of pregnancy and placenta praevia.1 Spontaneous haemoperitoneum, mostly associated with endometriosis infiltrating the broad and uterosacral ligaments and the Douglas pouch, is a potentially fatal but rare event. Placenta praevia is more common, 1-3 and it is important to define its incidence, the association with different lesion types, the impact of additional risk factors, the potential obstetrical consequences, and the information that women should receive.The association between endometriosis and placenta praevia Reliable estimates of the risk of placenta praevia in women with endometriosis could be obtained by investigating large population-based national cohorts. Harada et al.2 used data of the Japan Environment and Children's Study to evaluate obstetrical outcomes in 9186 pregnant women with (n = 330) or without (n = 8856) a self-reported history of endometriosis. Placenta praevia was observed in 3.6% of women with endometriosis and 0.6% of those without the disease (adjusted OR, 6.4; 95% CI, 3.2-12.6).2 Saraswat et al., using Scottish Record Linkage System data, compared late pregnancy outcomes in 4232 women with and 6707 without a diagnosis of endometriosis. The rate of placenta praevia was 1.7% in the former group and 0.8% in the latter (adjusted OR, 2.2; 95% CI, 1.5-3.3).3 Berlac et al., extracting data from the Danish Health Register and the Medical Birth Register, observed a higher risk of several obstetrical and neonatal complications in the 11 739 patients with endometriosis compared with the 615 533 women without a diagnosis of endometriosis. The highest risk was observed for pregnancies complicated by placenta praevia (2.1% versus 0.5%, respectively; OR, 3.9; 95% CI, 3.5-4.3).1

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Section: The Effect Of Severe Forms Of Endometriosis and Deep Lesionssupporting

confidence: 54%

Section: The Effect Of Severe Forms Of Endometriosis and Deep Lesionsmentioning

confidence: 98%

The ominous association between severe endometriosis, in vitro fertilisation, and placenta previa: raising awareness, limiting risks, informing women

Vercellini

Frattaruolo

Barbara

et al. 2017

BJOG

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“…The six studies were conducted between 2006 and 2018, and four were published after 2015. The studies were conducted in Japan (n=2), Turkey (n=1), Italy (n=1), Taiwan (n=1), and Korea (n=1) . The sample size ranged from 69 to 8326 women.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta‐analysis of adverse pregnancy outcomes after uterine adenomyosis

Razavi

Maleki‐Hajiagha

Sepidarkish

et al. 2019

Intl J Gynecology & Obste

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Background Studies on the impact of adenomyosis and its pregnancy complications have yielded conflicting results. Objective To determine the likelihood of adverse pregnancy outcomes among women with adenomyosis relative to women without adenomyosis. Search strategy PubMed, Embase, Scopus, and Web of Science were searched for studies published up to June 15, 2018. Selection criteria Observational studies with medically confirmed pregnancy outcomes as endpoints. Data collection and analysis Two researchers independently screened and selected relevant studies. Dichotomous data for all adverse pregnancy outcomes were expressed as an odds ratio (OR) with 95% confidence interval (CI), and combined in a meta‐analysis by using a random‐effects model. Main results Six studies (322 cases and 9420 controls) were eligible for inclusion in the meta‐analysis. Women with adenomyosis had an increased likelihood of preterm birth (OR, 3.05; 95% CI, 2.08–4.47; P˂0.001), small for gestational age (OR, 3.22; 95% CI, 1.71–6.08; P˂0.001), and pre‐eclampsia (OR, 4.35; 95% CI, 1.07–17.72; P=0.042). Conclusion Adenomyosis seems to have a detrimental impact on pregnancy outcomes, resulting in a higher likelihood of preterm birth, small for gestational age, and pre‐eclampsia.

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“…Several studies provide enough evidence to show that transvaginal ultrasound (TVUS) is not only useful, but a strategic tool in the preoperative mapping of lesions and in surgery planning (Ferreira & Carneiro, 2010; Dunselman et al. , 2014; Exacoustos et al , 2016). …”

Section: Resultsmentioning

confidence: 99%

“…Women with incomplete surgical removal of posterior DIE may nevertheless present with a higher of risk complications during pregnancy and delivery. (Exacoustos et al , 2016). …”

Section: Introductionmentioning

confidence: 99%

To operate or not to operate on women with deep infiltrating endometriosis (DIE) before in vitro fertilization (IVF)

Carneiro¹,

Costa²,

Ávila³

2017

JBRA Assisted Reproduction

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Deep infiltrating endometriosis (DIE) can cause infertility and pelvic pain. There is little evidence of a clear connection between DIE and infertility, and the absolute benefits of surgery for DIE have not been established. This paper aimed to review the current literature on the effect of surgery for DIE on fertility, pregnancy, and IVF outcomes. Clinicians should bear in mind that a comprehensive clinical history is useful to identify patients at risk for endometriosis, although many women remain asymptomatic. Imaging can be useful to plan surgery. The effect of surgery on the fertility of women with DIE remains unanswered due to the heterogeneous nature of the disease and the lack of trials with enough statistical power and adequate follow-up. Surgery is not recommended when the main goal is to treat infertility or to improve IVF results. Decisions should be tailored according to the individual needs of each woman. Patients must be provided information on the potential benefits, harm, and costs of each treatment alternative, while the medical team observes factors such as presence of pelvic pain, patient age, lesion location, and previous treatments. In this scenario, management by a multidisciplinary endometriosis team is a key step to achieving successful outcomes.

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Complications during pregnancy and delivery in women with untreated rectovaginal deep infiltrating endometriosis

Abstract: Women with an incomplete removal of posterior DIE have a high complications rate during pregnancy and delivery.

Cited by 87 publications

References 36 publications

The ominous association between severe endometriosis, in vitro fertilisation, and placenta previa: raising awareness, limiting risks, informing women

The ominous association between severe endometriosis, in vitro fertilisation, and placenta previa: raising awareness, limiting risks, informing women

Systematic review and meta‐analysis of adverse pregnancy outcomes after uterine adenomyosis

To operate or not to operate on women with deep infiltrating endometriosis (DIE) before in vitro fertilization (IVF)

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