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

Abstract

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.

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

“…A total of 11 cohort studies investigated hypertensive disorders in pregnancy overall [25,30,34,38,44,45,49,51,53,59,60]. Five were eligible for the main meta-analysis [30,34,38,51,53], without statistically significant difference between exposed and non-exposed to endometriosis ( Figure 2).…”

“…A total of 13 cohorts were found on endometriosis and gestational age at birth. Seven studies found women with endometriosis to have a shorter duration of pregnancy compared to women without endometriosis [31,[39][40][41]43,55,60]. Two of these received a NOS score ≥7 [39,40].…”

“…However, cesarean sections may cause severe maternal complications compared to vaginal deliveries [69]. We identified 28 cohort studies investigating the risk of cesarean section in women with endometriosis [25][26][27][28]30,31,33,37,[39][40][41][42][44][45][46][47][48][49][50]52,53,[55][56][57][59][60][61][62]. Ten of these were included in the main meta-analysis [27,28,30,37,39,40,53,56,57,62] (Figure 10), which showed an increased risk of cesarean section with an OR of 1.49 (95% CI: 1.35-1.65).…”

“…Hemorrhage is the leading cause of maternal death worldwide, and PPH accounts for two-thirds of these [71]. We identified 15 cohort studies investigating the association between endometriosis and PPH [28,30,31,37,41,44,47,49,50,52,53,55,59,60,62]. Five of these were included in the main meta-analysis [28,30,37,53,62], without reaching statistically significance ( Figure 12).…”

The association of endometriosis with placenta previa and postpartum hemorrhage: a systematic review and meta-analysis

“…6,7,15,16,21,28−41 The eligible studies were published between 2010 and 2020, all of which were retrospective studies, and none was a randomized controlled study; all studies were comparator studies. 6,7,15,16,21,28−41 Nearly a third of the studies were from Europe (n=8 [42.1%]), 6,7,15,28,32,34,35,38 followed by Japan (n=4 [21.1%]), 16,36,37,40 China (n=3 [15.8%]), 29,33,39 Korea (n=1 [5.3%]), 21 Israel (n=1 [5.3%]), 30 Canada (n=1 [5.3%]), 31 and Australia (n=1 [5.3%]). 41 All 19 studies examined the effect of endometriosis on the incidence of placenta previa (Table 1).…”