{"paper_id":"cead7eb2-a49e-4bb3-b4ec-3187bdb65de2","body_text":"~ 83 ~ \nInternational Journal of Clinical Obstetrics and Gynaecology 2025; 9(3): 83-85 \n \nISSN (P): 2522-6614 \nISSN (E): 2522-6622 \n© Gynaecology Journal \nwww.gynaecologyjournal.com \n2025;9(3): 83-85 \nReceived: 19-02-2025 \nAccepted: 23-03-2025 \n \nMontacer Hafsi \nDepartment of Gynecology and \nObstetrics, Menzel Temim, Nabeul, \nTunisia \n \nHoussem Ragmoun \nDepartment of Gynecology and \nObstetrics, Menzel Temim, Nabeul, \nTunisia \n \nEya Kristou \nDepartment of Gynecology and \nObstetrics, Menzel Temim, Nabeul, \nTunisia \n \nAmina Abaab  \nDepartment of Gynecology and \nObstetrics, Menzel Temim, Nabeul, \nTunisia \n \nMeriem Bezzine \nDepartment of Gynecology and \nObstetrics, Menzel Temim, Nabeul, \nTunisia \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nCorresponding Author: \nMontacer Hafsi \nDepartment of Gynecology and \nObstetrics, Menzel Temim, Nabeul, \nTunisia \n \nManagement of endometriosis in a level 2B maternity \nunit: A retrospective study \n \nMontacer Hafsi, Houssem Ragmoun, Eya Kristou, Amina Abaab  and \nMeriem Bezzine \n \nDOI: https://doi.org/10.33545/gynae.2025.v9.i3b.1632  \n \nAbstract \nIntroduction: Endometriosis, a chronic gynecological conditio n, complicates fertility and pregnancy \nmanagement, requiring tailored approaches in maternity units. This study evaluates the management of \nendometriosis in a level 2B maternity unit.  \nMethods: A retrospective study was conducted at Menzel Temime Regional Hospital, Tunisia, from \nJanuary 2022 to December 2024, including 60 women with confirmed endometriosis managed during \npreconception or pregnancy. Data on demographics, clinical presentation, diagnostic methods, treatment \nstrategies, and maternal-fetal outcomes were analyzed.  \nResults: Mean age was 32.4 years; 70% had infertility history. Diagnosis was confirmed by laparoscopy \n(65%) or imaging (35%). Preconception management included hormonal therapy (50%) and assisted \nreproductive techniques (30%). During p regnancy, 40% required pain management, and 25% experienced \ncomplications (e.g., preterm labor). Live birth rate was 85%, with no significant maternal morbidity. \nConclusion: Effective endometriosis management in a level 2B maternity unit involves multidisc iplinary \ncare, balancing hormonal, surgical, and obstetric interventions. Preconception optimization enhances \npregnancy outcomes. \n \nKeywords: Endometriosis, maternity unit, pregnancy, fertility, multidisciplinary care \n \n1. Introduction  \nEndometriosis, characterized by ectopic endometrial tissue, affects 10 -15% of reproductive- age \nwomen, significantly impacting fertility and quality of life [1]. Symptoms include dysmenorrhea, \nchronic pelvic pain, and infertility, with 30 -50% of affected women ex - periencing conception \ndifficulties [2]. In pregnancy, endometriosis may increase risks of preterm labor, placenta previa, \nand cesarean delivery [3]. \nLevel 2B maternity units, equipped for moderate -risk pregnancies, face unique chal - lenges \nmanaging endometriosis due to  limited specialized resources compared to level 3 units [4]. \nEffective management requires integrating gynecological, fertility, and obstetric  care, often \ninvolving hormonal suppression, surgical intervention, or assisted reproductive technologies \n(ART) [5]. This study assesses the management strategies and outcomes of endometriosis in a \nlevel 2B maternity unit at Menzel Temime Regional Hospital, Tunisia, to inform best practices \nin similar settings. \n \n2. Materials and Methods \nThis retrospective study was c onducted at the Gynecology -Obstetrics Department of Menzel \nTemime Regional Hospital, a level 2B maternity unit in Tunisia, from January 1, 2022, to \nDecember 31, 2024. The study included 60 women with histologically or clinically confirmed \nendometriosis managed during preconception or pregnancy. Exclusion criteria were incomplete \nrecords or management exclusively outside the maternity unit. \nData were collected from medical records, including demographics, endometriosis stage \n(American Society for Reproductiv e Medicine classification), diagnostic methods (laparoscopy, \nultrasound, MRI), preconception treatments (hormonal, surgical, ART), pregnancy management \n(pain relief, monitoring), and maternal -fetal outcomes. Com - plications assessed included \npreterm labor (<37 weeks), placenta previa, and cesarean delivery. \nDescriptive statistics summarized patient characteristics (means ± SD for continuous variables, \npercentages for categorical). Chi-square tests compared categorical outcomes, and Student’s t- \n\n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 84 ~ \ntest analy zed continuous variables. Statistical analysis used \nSPSS 25.0, with significance at p < 0.05. Ethical approval \nensured data anonymity, with no conflicts of interest declared. \n \n3. Results \n3.1 Population Characteristics \nThe cohort included 60 women with a me an age of 32.4 years \n(range: 24-41). Of these, 70% (42/60) had a history of infertility, \nand 55% (33/60) were primiparous. Endometriosis was staged as \nminimal/mild (stage I/II) in 45% (27/60) and moderate/severe \n(stage III/IV) in 55% (33/60) (Table 1). \n \n3.2 Diagnostic Methods \nDiagnosis was confirmed by laparoscopy in 65% (39/60), \nultrasound in 25% (15/60), and MRI in 10% (6/60). Ultrasound \nidentified endometriomas in 80% of imaging -based diagnoses, \nwith MRI used for deep infiltrating endometriosis (DIE). \nPreconception la - paroscopy was diagnostic and therapeutic in \n50% (30/60), reducing pain and improving fertility (Table 2). \n  \nTable 1: Demographic and Clinical Characteristics \n \nCharacteristic Value \nAge (mean, years) 32.4 ± 4.8 \nBMI (mean, kg/m²) 25.6 ± 3.9 \nPrimiparous 33 (55.0%) \nInfertility history 42 (70.0%) \nEndometriosis stage I/II 27 (45.0%) \nEndometriosis stage III/IV 33 (55.0%) \nRural residence 38 (63.3%) \n \nTable 2: Diagnostic Methods \n \nMethod Frequency (%) \nLaparoscopy 39 (65.0) \nUltrasound 15 (25.0) \nMRI 6 (10.0) \nEndometrioma (ultrasound) cases) 12 (80.0 of ultrasound  \nDeep infiltrating endometriosis (MRI) 5 (83.3 of MRI cases) \n \n3.3 Preconception Management \nPreconception treatment included hormonal therapy (combined \noral contraceptives or progesti ns) in 50% (30/60), surgical \nresection of endometriomas or DIE in 35% (21/60), and ART (in \nvitro fertilization or intrauterine insemination) in 30% (18/60). \nART was used in 42.9% (18/42) of infertility cases, with a \n66.7% (12/18) conception rate (Table 3). \n \nTable 3: Preconception Management Strategies \n \nTreatment Frequency (%) Success Rate (%) \nHormonal therapy 30 (50.0) 80.0 (pain reduction) \nSurgical resection 21 (35.0) 71.4 (fertility improvement) \nART 18 (30.0) 66.7 (conception) \nNo treatment 12 (20.0) - \n \n3.4 Pregnancy Management \nDuring pregnancy, 40% (24/60) required pain management \n(paracetamol or low -dose NSAIDs), and 15% (9/60) used \nprogestins for symptom control. Enhanced monitoring (biweekly \nultrasounds) was implemented in 60% (36/60) due to stage \nIII/IV disease or  infertility history. Complications included \npreterm labor (15%, 9/60), placenta previa (5%, 3/60), and \ncesarean delivery (45%, 27/60) (Table 4). \n \nTable 4: Pregnancy Management and Complications \n \nParameter Frequency (%) \nPain management 24 (40.0) \nProgestin use 9 (15.0) \nEnhanced monitoring 36 (60.0) \nPreterm labor 9 (15.0) \nPlacenta previa 3 (5.0) \nCesarean delivery 27 (45.0) \n \n3.5 Maternal-Fetal Outcomes \nLive birth rate was 85% (51/60), with 10% (6/60) spontaneous \nabortions and 5% (3/60)  stillbirths. Mean gestational age at \ndelivery was 37.8 weeks, with 12% (7/60) preterm births. \nNeonatal outcomes included a mean birthweight of 3,100 g and \n8% (5/60) neonatal ICU admissions, primarily for prematurity. \nNo significant maternal morbidity (e.g., severe hemorrhage) was \nreported, and 90% (54/60) resumed normal activities by 6 \nmonths postpartum (Table 5). \n \nTable 5: Maternal and Fetal Outcomes \n \nOutcome Frequency (%) \nLive births 51 (85.0) \nSpontaneous abortion 6 (10.0) \nStillbirth 3 (5.0) \nGestational age (mean, weeks) 37.8 ± 1.9 \nPreterm birth 7 (12.0) \nBirthweight (mean, g) 3,100 ± 450 \nNeonatal ICU admission 5 (8.0) \nMaternal morbidity (severe) 0 (0.0) \nNormal activity at 6 months 54 (90.0) \n \n4. Discussion \nThis study demonstrates effective manage ment of endometriosis \nin a level 2B maternity unit, achieving an 85% live birth rate \ndespite a 70% infertility prevalence [1]. Laparoscopy was the \nprimary diagnostic tool (65%), aligning with guidelines for its \ndual diagnostic - therapeutic role [5]. Ultras ound and MRI \ncomplemented diagnosis, particularly for endometriomas and \nDIE, consistent with reported sensitivities of 80-90% [4, 6]. \n Preconception hormonal therapy (50%) and surgery (35%) \nimproved fertility and pain, supporting their use in optimizing \npregnancy chances [2]. ART’s 66.7% success rate underscores its \nvalue for infertility [7]. In pregnancy, pain management (40%) \nand progestins (15%) controlled symptoms, though preterm \nlabor (15%) and cesarean rates (45%) were elevated, \ncorroborating increase d obstetric risks [3, 8] . The absence of \nsevere maternal morbidity reflects coordinated care, despite \nlimited resources [9]. \nLimitations include the retrospective design, small sample size, \nand lack of long- term follow-up. The level 2B setting may limit \ngeneralizability to higher -tier units with advanced surgical \ncapabilities [10]. Future studies should explore minimally \ninvasive techniques and cost-effectiveness in similar settings [11]. \n \n5. Conclusion \nManaging endometriosis in a level 2B maternity unit r equires a \nmultidisciplinary approach integrating preconception \noptimization, targeted pregnancy monitoring, and obstetric care. \nHormonal therapy, surgery, and ART enhance fertility, while \nvigilant pregnancy management mitigates complications. These \nfindings support feasible, effective care in moderate -resource \nsettings, with further research needed to refine protocols. \n \n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 85 ~ \nConflict of Interest \nNot available  \n \nFinancial Support \nNot available \n \n6. References \n1. Bulletti C, Coccia ME, Battistoni S, Borini A. \nEndometriosis and infertility. J Assist Reprod Genet. \n2010;27(8):441-7. \n2. de Ziegler D, Borghese B, Chapron C. Endometriosis and \ninfertility: pathophysiology and management. Lancet. \n2010;376(9742):730-8. \n3. Leone Roberti Maggiore U, Ferrero S, Mangili G, \nBergamini A, Inversetti A, Giorgione V, et al . \nEndometriosis and pregnancy outcome: a review. Arch \nGynecol Obstet. 2014;289(6):1153-60. \n4. Vercellini P, Viganò P, Somigliana E, Fedele L. \nEndometriosis: pathogenesis and treatment. Nat Rev \nEndocrinol. 2014;10(5):261-75. \n5. Dunselman GA, Vermeulen N, Becker C, Calhaz -Jorge C, \nD’Hooghe T, De Bie B, et al . ESHRE guideline: \nmanagement of women with endometriosis. Hum Reprod. \n2014;29(3):400-12. \n6. Exacoustos C, Malzoni M, Di Giovanni A, Lazzeri L, Tosti \nC, Petraglia F, et al. Ultrasound diagnosis of endometriosis: \naccuracy and implications for clinical management. \nUltrasound Obstet Gynecol. 2014;43(2):122-31. \n7. Sallam HN. Endometriosis and assisted reproductive \ntechnologies. Reprod Biomed Online. 2008;17(Suppl 3):15 -\n22. \n8. Zullo F, Spagnolo E, Saccone G, Acunzo G, Xodo S, \nCeccaroni M, et al . Endometriosis and obstetric \ncomplications: a systematic review and meta-analysis. Fertil \nSteril. 2017;108(4):667-72. \n9. Johnson NP, Hummelshoj L, Adamson GD, Keckstein J, \nTaylor HS, Abrao MS, et al. World En dometriosis Society \nconsensus on the classification of endometriosis. Hum \nReprod. 2017;32(2):315-24. \n10. Hornstein MD. Endometriosis: a review of current \ndiagnostic and treatment options. Fertil Steril. \n2018;110(4):630-7. \n11. Berlanda N, Somigliana E, Vigano P. Ma nagement of \nendometriosis in women seeking fertility: a review. J Clin \nMed. 2019;8(10):1668. \n \nHow to Cite This Article \nHafsi M, Ragmoun  H, Kristou  E, Abaab A, Bezzine M. Management of \nendometriosis in a level 2B maternity unit: A retrospective study . \nInternational Journal of Clinical Obstetrics and Gynaecology . \n2025;9(3):83-85.  \n \n \nCreative Commons (CC) License \nThis is an open access journal, and articles are distributed under the terms \nof the Creative Commons Attribution -NonCommercial-ShareAlike 4.0 \nInternational (CC BY -NC-SA 4.0) License, which allows others to remix, \ntweak, and build upon the work non -commercially, as long as appropriate \ncredit is given and the new creations are licensed under the identical terms.","source_license":"CC0","license_restricted":false}