Obstetrical complications of endometriosis, particularly deep endometriosis

Maggiore, Umberto Leone Roberti; Inversetti, Annalisa; Schimberni, Mauro; Viganò, Paola; Giorgione, Veronica; Candiani, Massimo

doi:10.1016/j.fertnstert.2017.10.035

Cited by 48 publications

(38 citation statements)

References 120 publications

(168 reference statements)

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“…We found an increased incidence of caesarean sections in the case group compared to controls, mainly performed in elective regimen. Several meta-analyses and reviews found a correlation between endometriosis and caesarean section [29,34]. In a study performed by Maggiore et al, the main indication for caesarean section in women with endometriosis was fetal distress, followed by breech presentation and dystocia [26].…”

Section: Discussionmentioning

confidence: 99%

Endometriosis and Pregnancy: A Single Institution Experience

Porpora

Tomao

Ticino

et al. 2020

IJERPH

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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.

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Section: Discussionmentioning

confidence: 99%

Endometriosis and Pregnancy: A Single Institution Experience

Porpora

Tomao

Ticino

et al. 2020

IJERPH

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“…[18][19][20][21][22][23][24][25][26] However, two interesting and comprehensive reviews by Leone Roberti Maggiore et al have highlighted that the risk of complications associated with endometriosis during pregnancy is low. 23,24 While the available literature suggests that there is an increased risk of placenta previa, particularly in patients with deep endometriosis, pregnant women with endometriosis should be in general reassured regarding the course of their gestation. Few studies, however, have focused on the possible similarities and differences among the different types and locations of endometriosis.…”

Section: Discussionmentioning

confidence: 99%

“…23 However, a nonnegligible increase in the likelihood of placenta accrete, preterm birth, and aesarean delivery has been described. [23][24][25][26] Unfortunately, most of the available evidence relies either on population-based studies, which used codes of the diagnoses for both the mother and the newborn at the time of discharge from the hospital, or on small retrospective collections of data with conflicting results. Moreover, attention has been given almost exclusively to pregnancy and maternal outcomes, whereas scant data are available on the neonates.…”

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confidence: 99%

Pregnancy after Endometriosis: Maternal and Neonatal Outcomes according to the Location of the Disease

et al. 2019

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Objective To systematically evaluate pregnancy and labor course, obstetrical complications, and maternal and neonatal outcomes in women with endometriosis, stratifying according to the specific location of the disease. Study Design We retrospectively analyzed our prospectively maintained obstetrical database from January 2011 to August 2014 to identify all women with a previous histological diagnosis of endometriosis who delivered at our institution (cases). We divided the cases according to the specific location of the disease (deep infiltrating endometriosis, ovarian endometriosis, and peritoneal endometriosis). As controls, we identified all unaffected women who delivered in the year 2013. To avoid the confounding effect of parity, we limited our analysis to nulliparous women. Results A total of 118 nulliparous women with endometriosis and 1,690 nulliparous controls were identified. Women with endometriosis were significantly older, had a lower body mass index, and had a higher incidence of assisted reproductive technology. The duration of pregnancy was significantly shorter among women with endometriosis. A higher incidence of placenta previa (3.4 vs. 0.5%; p = 0.006), hypertension (11 vs. 5.9%; p = 0.04), cesarean section (41.5 vs. 24.2%; p < 0.0001), and vacuum delivery (10.1 vs. 2.9%; p = 0.006) was found in women with endometriosis. Neonatal outcomes were similar between groups. The incidence of placenta previa in patients with deep endometriosis was 11.7 versus 0.5% among controls (p < 0.0001), whereas in women with ovarian and peritoneal endometriosis, it was similar to the controls. Conclusion Women with endometriosis have a higher incidence of vacuum delivery, cesarean section, and placenta previa compared with unaffected women. The higher risk of placenta previa is attributable exclusively to women with deep endometriosis. Neonatal outcomes are unaffected by the presence of the disease.

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“…Saraswat et al compared late pregnancy outcomes in 4232 women with endometriosis and 6707 without endometriosis and reported that the rate of placenta previa was 1.7% in the former group and 0.8% in the latter (adjusted odds ratio, 2.2; 95% CI, 1.5-3.3) [16,17]. Other studies have also reported that the incidence of placenta previa is high in patients with endometriosis [4,5,18]; thus, the frequency at which obstetricians encounter placenta previa or PAS may increase with an increase in the incidence of endometriosis.…”

Section: Discussionmentioning

confidence: 99%

Horizontal Cervix as a Novel Sign for Predicting Adhesions on the Posterior Extrauterine Wall in Cases of Placenta Previa

Matsuzaki

Okada

Endo

et al. 2019

JCM

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We aimed to identify a magnetic resonance imaging (MRI) feature that can predict posterior extrauterine adhesion (posterior adhesion) antenatally, in patients with placenta previa. We retrospectively reviewed patients with placenta previa who underwent a preoperative MRI examination of placenta accreta spectrum. We categorized the patients into two groups based on whether the cervix was anterior or posterior to a line perpendicular to the anatomical conjugate on the MRI. We projected the perpendicular line toward a straight line through the broad of the back on T2-weighted sagittal MRI images and measured the angle between this line and the line passing through the cervical canal. We analyzed the correlation of the cervical canal angle with the presence of posterior adhesions. Of the 96 patients analyzed, 71 patients had an anteverted cervix and 25 patients had a retroverted cervix. There were 21 posterior adhesions. The adhesion rate was significantly higher in patients with a retroverted cervix than those with an anteverted cervix (8.5% vs. 60%; p = 0.00). The cervical canal angle was ≤10° in 25 patients; of these 17 had adhesions (sensitivity, 81.0%; specificity, 89.3%; area under the curve, 0.887; 95% confidence interval, 0.792–0.981). This finding, labeled “positive horizontal cervix sign,” may be a promising indicator of posterior adhesions in patients with placenta previa.

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Obstetrical complications of endometriosis, particularly deep endometriosis

Cited by 48 publications

References 120 publications

Endometriosis and Pregnancy: A Single Institution Experience

Endometriosis and Pregnancy: A Single Institution Experience

Pregnancy after Endometriosis: Maternal and Neonatal Outcomes according to the Location of the Disease

Horizontal Cervix as a Novel Sign for Predicting Adhesions on the Posterior Extrauterine Wall in Cases of Placenta Previa

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