Pregnancy with endometriosis

Maternal and neonatal outcomes according to the location of the disease

Key Points

Highlights:

• 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 seen predominantly in women with deep endometriosis
• Neonatal outcomes are unaffected by the presence of endometriosis

Importance:

• Despite the rising rates of pregnant women with endometriosis, information regarding the possible effect of the disease on obstetrical and neonatal outcomes is still sparse
• Most of the available studies focus on pregnancy and maternal outcomes, thus, data on the neonates is lacking

What’s done here?

• Systematic retrospective analyses of pregnancy and labor, obstetrical complications, and maternal and neonatal outcomes in women with endometriosis, based on the specific location of the disease

Key results:

• Women with endometriosis were significantly older 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 (only in women with deep endometriosis), hypertension, cesarean section, and vacuum delivery was found in women with endometriosis
• Neonatal outcomes were similar between groups

Limitations of the study:

• The retrospective design may have caused possible selection, detection and reporting bias
• The study did not take into account the surgical interventions performed for endometriosis, particularly for deep endometriosis; and assumed all patients included in this study had optimal removal of endometriosis at the time of surgery before the onset of pregnancy

Lay Summary

Current literature suggests that complications of endometriosis during pregnancy are rare; however, a non-negligible increase in the likelihood of placenta accreta (placenta grows too deeply into the uterine wall), preterm birth, and cesarean delivery has been reported. With the increase in the pregnancy rates in women with endometriosis, it became integral to fully understand any possible effects of endometriosis on pregnant women and newborns.

This recent study by Dr. Uccella and colleagues focused on this very concern: Maternal and neonatal outcomes in women with endometriosis. The study analyzed available data from 118 pregnant women with endometriosis during pregnancy, labor and postpartum periods. The paper is published in the July issue of American Journal of Perinatology.

Placenta previa and hypertension were among the disorders seen in women with endometriosis. Especially in women with deep endometriosis, the incidence of placenta previa was about 20 times higher than that in patients without endometriosis. Women with endometriosis also had a lower likelihood of the spontaneous onset of labor and a higher incidence of cesarean section and vacuum delivery compared with patients without endometriosis.

On the other hand, neonatal outcomes were not affected by the presence and location of endometriosis. Even in the cases with deep endometriosis, no negative impact was observed on the newborns’ health. The outcomes studied include birth weight, Apgar score at 5 minutes, umbilical artery pH at birth, the incidence of pH < 7, and neonatal intensive care unit (NICU) admissions.

Authors conclude that although patients with deep endometriosis have a considerably higher risk of placenta previa, the overall outcomes of pregnancy and, in particular, the neonatal outcomes are in line with those of unaffected women.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/31238367