Is there an Increased Risk for Unfavorable Obstetric Outcomes in Women with Endometriosis? An Evaluation of Evidences

Abstract

Objective The present study is a systematic review of the literature to assess whether the presence of endometriosis determines or contributes to adverse obstetric outcomes. Data Sources The present work was carried out at the Hospital Israelita Albert Einstein, São Paulo, state of São Paulo, Brazil, in accordance to the PRISMA methodology for systematic reviews. A review of the literature was performed using PubMed, Web of Science and Scopus databases. The keywords used were: pregnancy outcome, pregnancy complications, obstetrical complications, obstetrics, obstetric outcomes and endometriosis. The survey was further completed by a manually executed review of cross-referenced articles, which was last performed on November 30, 2018. Selection of studies The survey disclosed a total of 2,468 articles, published from May 1946 to October 2017. A total of 18 studies were selected to be further classified according to their quality and relevance. Data Collection The Newcastle–Ottawa Quality Assessment Scale was used for classification. Five studies of greater impact and superior evidence quality and 13 studies of moderate evidence quality were selected. We analyzed the studies for the characteristics of their patients plus how endometriosis was diagnosed and their respective obstetric outcomes taking into account their statistical relevance. Data Synthesis Analyses of the higher impact and better quality studies have shown high incidence of preterm birth and placenta previa in patients with endometriosis. Conclusion Placenta previa and preterm birth are the most statistically significant outcomes related to endometriosis, as indicated by our systematic review. The present information is useful to alert obstetricians and patients about possible unfavorable obstetric outcomes.

Localização de células senescentes nas lesões de pacientes com endometriose profunda

“…(45) Dessa forma, se pensarmos nos custos de diagnóstico e tratamento anuais, que chegam a somar €10.000 em países europeus; $4.000 dólares por paciente segundo o sistema de saúde americano (46) e $1.8 bilhões por ano somando todos os gastos no Canadá, (47) juntamente com os altos índices de ausência no trabalho, (4) impacto na saúde física e psicológica das pacientes, (36,48,49) como pelo impacto socioeconômico diante de possíveis consequências na vida escolar, (50) esta doença pode ser considerada um problema de saúde pública (39,51,52) e merece atenção. (53,54) O quadro clínico da endometriose pode estar associado à infertilidade, comprometimento da qualidade oocitária, (32,55,56) efeitos adversos na gestação, (57,58) dismenorreia, dispareunia de profundidade, dor pélvica acíclica, alterações do hábito intestinal e urinário. (59,60) Outros sintomas como fadiga, inchaço ou náusea, principalmente durante os períodos menstruais, somatização, depressão e ansiedade, também são observados em pacientes com endometriose quando comparados aos grupos de mulheres sem a doença.…”