Pregnancy Risks Associated with Severe Endometriosis

Placenta praevia is the most common pregnancy risk that is increased in individuals with severe endometriosis and in endometriosis patients that chose to use fertility treatments.

Key Points

Highlights:

• Women with endometriosis who wish to get pregnant can face many complications in the second half of their pregnancy such as spontaneous haemoperitoneum and placenta praevia.

Importance:

• Spontaneous haemoperitoneum, while not common, can be fatal.
• Individuals who have endometriosis should be informed of the risks that are associated with a possible pregnancy.

What’s done here?

• The authors of the paper asked and answered the following questions over the course of the article:
  • What is the link between endometriosis and placenta praevia?
  • How does the incidence of placenta praevia change for individuals with severe endometriosis?
  • How does the impact of placenta praevia change when a person decides to use assisted reproduction techniques?
  • What are the consequences of placenta praevia?
  • What are possible methods for patient education for these complications?

Key results:

• The risk of placenta praevia is higher for individuals who have endometriosis compared to people who do not have the disease. There is also an increased risk of neonatal and obstetrical complications for patients with endometriosis and placenta praevia pregnancies.
• Endometriotic lesions increase the incidence of placenta praevia; however, there is no difference in the rates of placenta praevia for those individuals with superficial and severe endometriosis. Additionally, the mechanism that governs the relationship between severe endometriosis and placenta praevia is still unknown.
• Assisted reproduction techniques increase the incidence of placenta praevia and individuals with endometriosis that use fertility treatments have an even higher rate of placenta praevia.
• Adherent placenta praevia in individuals with deep endometriosis can lead to postpartum hemorrhage and an emergency cesarean hysterectomy.
• Risks of placenta praevia can be minimized in an IVF setting by using elective single embryo transfer for individuals with deep endometriosis. 
• Patients with endometriosis should be informed about the risks of pregnancy so that they may make informed decisions.

Limitations of the study:

• There are still many unanswered questions about the relationship between severe endometriosis and pregnancy risks.

Lay Summary

Living with endometriosis can be painful and challenging; however, the challenges increase for women that are pregnant and have this disease. Recently, BJOG published an article titled “The ominous association between severe endometriosis, in-vitro fertilization, and placenta praevia: Raising awareness, limiting risks, informing women” that explores some of the symptoms that individuals with endometriosis experience during pregnancy. In this article, Vercellini et al. identify placenta praevia and spontaneous haemoperitoneum, occurring in the latter half of pregnancy as the most adverse complications caused by endometriosis.

Spontaneous haemoperitoneum does not often occur in women with endometriosis, but when it does, it can prove to be fatal. On the other hand, placenta praevia is more common. Within the scope of this paper, the authors looked at the association between endometriosis and placenta praevia; the incidence of placenta praevia in individuals with severe endometriosis; the impact of placenta praevia as a function of IVF, twinning and blastocyst transfer; the consequences of placenta praevia, and patient education about this condition.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/28618175