Endometriosis and Pregnancy: A Single Institution Experience

Abstract

Endometriosis may compromise the physiological course of pregnancy. The aim of this prospective observational study was to evaluate whether endometriosis causes a higher prevalence of obstetric and neonatal complications as well as a higher risk of caesarean section and to detect a possible correlation between the presence, type, and location of endometriosis and obstetric complications, previous surgery, and pregnancy outcome, as well as the influence of pregnancy on the course of the disease. We compared two cohorts of women with spontaneous pregnancy, with and without endometriosis. Obstetric and neonatal outcomes, mode of delivery, presence, type, and location of endometriotic lesions and the effect of pregnancy on the disease were analyzed. A total of 425 pregnancies were evaluated: 145 cases and 280 controls. Patients with endometriosis showed a higher incidence of miscarriage, threatened miscarriage, threatened preterm labor, preterm delivery, placental abruption, and a higher incidence of caesarean section. A significant correlation with pregnancy-induced hypertension and preeclampsia was found in the presence of adenomyosis. No difference in fetal outcome was found. One case of hemoperitoneum during pregnancy was observed. Pregnancy in women with endometriosis carries a higher risk of obstetric complications, such as miscarriage, threatened miscarriage, preterm labor, preterm birth, and a higher caesarean section rate. Endometriosis does not seem to influence fetal well-being.

Should the patients with endometriosis be treated as a risk group of pregnancy complications? Single center experience and literature review and literature review

“…Moreover, the authors observed higher incidence of placenta previa in the study group (1.6% vs 0%), but the result did not reach significance. These conclusions are concordant with the findings of previous researchers (reported OR 2.0-3.99 for placental abruption and 3.9-15.1 for placenta previa) [13,15,20,21].…”

“…According to our results, endometriosis seems to be positively correlated with the incidence of elective caesarean sections (OR = 1.8). This finding is concordant with previous studies (Porpora et al, Horton et al) [21,22]. Nevertheless, vaginal labor does not increase the risk of peritoneal injuries among women who underwent surgery for deep infiltrating endometriosis and may reduce the recurrence of endometriosis symptoms after delivery [23,24].…”

“…The authors of the presented paper did not evaluate the course of early pregnancies (< 22 nd week of gestation). Few publications hypothesize that endometriosis may be associated with early pregnancy loses (both spontaneous abortion and ectopic pregnancy), but these findings should be carefully interpreted (Farland et al, Porpora et al) [21]. Further studies should also focus on these issues.…”

Endometriosis and Risk of Adverse Pregnancy Outcome: A Systematic Review and Meta-Analysis

“…Heterogeneity was high (I 2 = 94%). Neither the secondary analysis including all studies regardless of study quality not the sub-analysis including only spontaneous pregnancies [45,48,52,57] changed the direction of the association between endometriosis and cesarean section (Supplementary Figure S17). The funnel plot was rather symmetrical (Supplementary Figure S18).…”

Endometriosis and spontaneous hemoperitoneum in pregnancy: evaluation of the magnitude of the risk in women becoming pregnant via in vitro fertilization

“…the number of pregnancies was not reported (5). More recent case series of pregnant women with endometriosis suggest that this risk may be very low but the relatively small number of included cases or the study designs hamper a precise estimate of the risk (6)(7)(8).…”