Effects of Bowel Endometriosis Surgery on Mode of Delivery

Most women are not counseled about the possible effects of bowel endometriosis surgery on their subsequent mode of delivery, study shows.

Key Points

Highlights: 

• Only about a third of doctors counsel their patients about the possible effects of bowel endometriosis surgery on their mode of delivery.

Importance:

• This finding suggests that guidance from the European Society of Gastrointestinal Endoscopy and/or The British Society for Gynaecological Endoscopy (BSGE) could be helpful to clinicians in counseling their patients appropriately and obtaining their informed consent before surgery.

What's done here:

• Researchers conducted an online survey among 102 members of BSGE.

Key results:

• 70% of BSGE members do not counsel women about their delivery options before endometriosis surgery. 
• Around a third of them recommend a planned Caesarean section if the vagina is opened.

Limitations:

• The researchers only reviewed the answers of gynecologists specializing in endometriosis but did not assess that of bowel surgeons or urologists with a special interest in endometriosis.

Lay Summary

Less than a third of doctors counsel women about the possible effects of surgical treatment of bowel endometriosis on their mode of delivery should they become pregnant, according to a new study published in the Journal of Obstetrics and Gynaecology.

“Our survey highlights [the] wide variation in practice that currently exists,” wrote the authors of the study and said that guidance from the European Society of Gastrointestinal Endoscopy and/or The British Society for Gynaecological Endoscopy (BSGE) could help clinicians counsel their patients appropriately and obtain their informed consent prior to the operation.

Bowel or intestinal endometriosis could be affecting as much as 37% of women with deep infiltrating endometriosis. Despite this high ratio, there are no guidelines or consensus about the safest method of delivery following bowel and/or intestinal endometriosis surgery.

In the present study, a team of researchers led by Dr. Mohamed M Hosni conducted an online survey among 102 members of the BSGE, of whom 61.76% were gynecologists in order to better understand what method of delivery they would recommend women who have had surgery to treat their bowel endometriosis and what factors influenced their recommendations. 

The results showed that only 30.39% of participants counsel women before the operation and one-third recommend a Caesarean section if the vagina is opened.

The researchers said that risk factors should be stratified for these patients before a vaginal delivery is attempted. “Further studies are required to stratify the risk factors for such patients when attempting vaginal delivery or cesarean section,” they added.

Research Source: https://pubmed.ncbi.nlm.nih.gov/34964412/