Pregnancy Complications Associated with Endometriosis
Pregnancy in women with endometriosis may be complicated by spontaneous hemoperitoneum, placenta previa, postpartum hemorrhage, and potentially preterm birth and SGA, with possible defective spiral artery remodeling playing a role.
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This paper reviews how endometriosis affects fertility and pregnancy, drawing on studies of natural conception and assisted reproduction, including IVF outcomes and obstetric complications. It reports that in both peritoneal and ovarian endometriosis there are adverse effects on ovulation rates, ovarian reserve markers, and ovarian stimulation response (with some improvement using intracytoplasmic sperm injection), and that when pregnancy occurs it may be complicated by spontaneous hemoperitoneum, placenta previa, and postpartum hemorrhage, while evidence for preeclampsia, small for gestational age, and preterm birth is mixed across cohorts. Limitations explicitly highlighted include inconsistent findings among studies regarding several pregnancy outcomes and an ongoing uncertainty about underlying mechanisms. Relevance to endometriosis: the paper is specifically about endometriosis-associated pregnancy complications, including infertility, risk of preterm birth and placenta-related outcomes, and proposes vascular remodeling abnormalities in endometriosis (and adenomyosis) as part of the pathophysiology.
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