Maternal and neonatal outcomes in women with colorectal endometriosis

Abstract

Due to the incidence of postpartum complications whatever the route of delivery, women should receive level III maternal care.

Obstetrical complications of endometriosis, particularly deep endometriosis

“…Jacques et al also did not find an increased rate of postpartum hemorrhage among patients with endometriosis compared with control subjects, even evaluating separately women with deep locations (n ¼ 39; 8.2%) versus women with ovarian locations (n ¼ 49; 7.7%), all analyzed after surgery (96). Thomin et al, considering 72 pregnancies of women affected by colorectal endometriosis and comparing those who delivered by means of CS (n ¼ 36) versus those who delivered vaginally (n ¼ 36), did not find differences between the two groups and reported only two cases of postpartum bleeding (2% globally) in the CS group (103). Petresin et al described a case of rectovaginal endometriosis left in situ during laparoscopic intervention (consent to treat it surgically was lacking) and causing, years later, recurrent heavy vaginal bleeding during the 27th and 28th weeks of gestation.…”

“…The rate of miscarriage, defined as the spontaneous interruption of pregnancy before 20 weeks of gestation (106), is often not reported in the studies aiming to investigate outcomes of women affected by DE (47,49,66,73,76,85,93,96,100,(103)(104)(105)111).…”

“…Another study evaluating only women affected by DE reported that the risk of gestational hypertensive disorders (3.8%; 10 out of 26 patients) did not seem to be increased in women with previous laparoscopic ureterolysis, compared with the risk in the general population of pregnant women (reported as 5%-10% for gestational hypertensive disorders globally and 3.9% for preeclampsia) (102). Thomin et al conducted a retrospective cohort study enrolling 72 pregnancies from 67 women affected by colorectal endometriosis, both in situ and resected, with the aim of evaluating delivery and neonatal outcomes in this specific population, describing only one case of preeclampsia (1.38%) (103). Similarly, an Italian group performed a retrospective cohort study on 40 women with DE versus 222 women without DE.…”

Medical treatment in the management of deep endometriosis infiltrating the proximal rectum and sigmoid colon: a comprehensive literature review

“…In fact, some cases of large bowel occlusion or perforation as well as hydroureteronephrosis have been reported during pregnancy (53)(54)(55). Abdominal procedures for complicated colorectal endometriosis in the presence of a gravid uterus may reveal technically demanding and risky for both the mother and the fetus (58,59). Surgery should be also discussed before undertaking in vitro fertilization, as similar complications have been observed during ovarian stimulation (56,57).…”

“…Surgery should be also discussed before undertaking in vitro fertilization, as similar complications have been observed during ovarian stimulation (56,57). Abdominal procedures for complicated colorectal endometriosis in the presence of a gravid uterus may reveal technically demanding and risky for both the mother and the fetus (58,59). Thus, women with sub-occlusive forms seeking pregnancy in the future should be thoroughly informed about the risks of not undergoing prior bowel surgery and should be referred to tertiary care endometriosis centers where expert abdominal surgeons are available for pre-conception evaluation and advice.…”