Deep endometriosis and pregnancy

The impact of deep endometriosis on regular pregnancy and delivery outcome

Key Points

Highlight:

• This is a review article summarizing the potential impact of deep endometriosis on pregnancy outcomes.

Importance:

• Complications of deep endometriosis during pregnancy can be unpredictable. Therefore, it is important to study whether endometriosis surgery can modify the impact of the disease on pregnancy.

What's done here:

• This review summarizes evidence on the relationship between deep endometriosis and obstetrical outcomes.

Data:

• Deep endometriosis is associated with higher rates of placenta previa
• The association of deep endometriosis and miscarriage, intrauterine growth restriction, preterm birth and hypertensive disorders are controversial.
• Currently available studies do not support prophylactic surgery to prevent obstetrical complications in women with endometriosis.

Limitations:

The impact of deep endometriosis on obstetrical outcomes is debatable due to a number potential limitations in studies including small sample size, lack of adjustment for confounders, lack of adequate control subjects, and methodological errors.

Lay Summary

Several previous studies have investigated whether endometriosis can affect the normal development of pregnancy, although the results have been controversial. The aim of this review article by Leone Roberti Maggiore et al. is to provide an updated overview of health evidence of the impact of deep endometriosis on obstetrical outcomes through evaluation of related articles from Pubmed database searches.

The current literature showed several types of acute complications that may occur during pregnancy in women with deep endometriosis. The most common being spontaneous hemoperitoneum (25 out of 120 cases), bowel perforation (17 out of 120), and uterine rupture (63 out of 120). However, based on available evidence, these complications in pregnant women with endometriosis are rare and unpredictable. It is also unclear whether surgical treatment of endometriosis before pregnancy can benefit these acute complications.

The results concerning deep endometriosis effects on pregnancy and delivery outcomes are controversial. Overall, there is a higher incidence of cesarean section among women with deep endometriosis. In particular, some studies showed a higher incidence of placenta previa in women affected by endometriosis. This higher rates of placenta previa may be due to abnormal frequency and amplitude of uterine contractions with endometriosis. The association of deep endometriosis and other factors including miscarriage, IUGR, preterm birth and hypertensive disorders are unclear. To date, no study has investigated the effectiveness of prophylactic surgery on obstetrical complications during pregnancy and delivery in women with endometriosis which prevents in-depth elucidation of the role of surgical treatment on this topic.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/29202964