Impact of endometriosis on obstetric outcome after natural conception: a multicenter Italian study

Abstract

Purpose To evaluate obstetric outcome in women with endometriosis who conceive naturally and receive standard obstetric care in Italy. Methods Cases were consecutive women with endometriosis managed in eleven Italian referral centers. Controls were women in whom endometriosis was excluded. All women filled in a questionnaire addressing previous natural pregnancies. Marginal logistic regression models were fitted to evaluate the impact of endometriosis on obstetric outcome. A post hoc analysis was performed within the endometriosis group comparing women with severe adenomyosis versus women with absent or mild adenomyosis. Results Three hundred and fifty-five pregnancies in endometriosis group and 741 pregnancies in control group were included. Women with endometriosis had a higher risk of preterm delivery < 34 weeks (6.4% vs 2.8%, OR 2.42, 95% CI 1.22–4.82), preterm delivery < 37 weeks (17.8% vs 9.7%, OR 1.98, 95% CI 1.23–3.19), and neonatal admission to Intensive Care Unit (14.1% vs 7.0%, OR 2.04, 95% CI 1.23–3.36). At post hoc analysis, women with endometriosis and severe adenomyosis had an increased risk of placenta previa (23.1% vs 1.8%, OR 16.68, 95% CI 3.49–79.71), cesarean delivery (84.6% vs 38.9%, OR 8.03, 95% CI 1.69–38.25) and preterm delivery < 34 weeks (23.1% vs 5.7%, OR 5.52, 95% CI 1.38–22.09). Conclusion Women with endometriosis who conceive naturally have increased risk of preterm delivery and neonatal admission to intensive care unit. When severe adenomyosis is coexistent with endometriosis, women may be at increased risk of placenta previa and cesarean delivery. Trial registration Clinical trial registration number: NCT03354793.

Reproductive and postsurgical outcomes of infertile women with deep infiltrating endometriosis

“…Several studies have shown that DIE lesions can increase the risk of premature delivery, placenta previa, placental abruption and gestational hypertension. The cesarean section rate and the incidence of surgical complications (such as hysterectomy, peritoneal hemorrhage and bladder injury) in DIE patients were significantly higher than those in the normal group [ 24 , 25 ].…”

Association between Endometriosis and Delivery Outcomes: A Systematic Review and Meta-Analysis

“…The study selection scheme is shown in Figure 1 . In the literature search, 2674 studies were examined and 28 studies, comprising 92,418 women with endometriosis and 4,626,840 women without endometriosis, met the inclusion criteria of this systematic literature review [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ]. The metadata of the included studies are summarized in Supplementary Files S2–S5 .…”

“…Twenty-eight of the eligible studies were retrospective studies, and none were randomized controlled trials. The studies included in this systematic review had been published between 2003 and 2021 in Europe ( n = 16 [57.1%]) [ 26 , 30 , 32 , 34 , 38 , 39 , 40 , 42 , 43 , 44 , 45 , 46 , 48 , 50 , 52 , 53 ], China ( n = 4 [14.3%]) [ 27 , 28 , 37 , 47 ], Japan ( n = 3 [10.7%]) [ 31 , 41 , 49 ], Israel ( n = 2 [7.1%]) [ 33 , 36 ], Australia ( n = 1 [3.6%]) [ 51 ], Canada ( n = 1 [3.6%]) [ 35 ], and Korea ( n = 1 [3.6%]) [ 29 ].…”

“…Of the 28 eligible studies, nine studies examined the effect of endometriosis on the rate of instrumental delivery ( Table 1 ) [ 31 , 32 , 33 , 34 , 38 , 39 , 44 , 48 , 53 ]. Twenty-seven studies investigated the effect of endometriosis on the risk of CD ( Table 2 ) [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 52 , 53 ], of which six studies conducted sensitivity analyses focusing on types of endometriosis ( Table 3 ) [ 32 , 34 , 40 , 44 , 46 , 50 ]. Furthermore, 17 studies examined the rate of PPH between pregnant women with and without endometriosis ( Table 4 ) […”

“…Of 28 included studies, 27 (5 of low and 22 of moderate quality) examined the association between endometriosis and the risk of CD ( Table 2 ) [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 52 , 53 ]. A random-effect analysis was conducted because of considerable heterogeneity.…”