Association of Endometriosis and Severe Maternal Morbidity

Nahantara Lafleur, Lafleur N, Wei SQ, Shu Qin Wei, Marianne Bilodeau‐Bertrand, Bilodeau-Bertrand M, Marianne Bilodeau-Bertrand, Nathalie Auger, Auger N
Obstetrics and gynecology · 2022 · vol. 140(6) , pp. 1008–1016 · doi:10.1097/aog.0000000000004969 · PMID:36357981 · W4308774671
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This study found that surgically confirmed endometriosis, particularly active endometriosis during pregnancy, is associated with a 43% increased risk of severe maternal morbidity.

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This population-based retrospective cohort study analyzed over two million deliveries in Quebec to evaluate the link between surgically confirmed endometriosis and severe maternal morbidity. The researchers found that patients with endometriosis faced a significantly higher risk of severe maternal morbidity compared to those without the condition, with active disease during pregnancy doubling the risk relative to no exposure. Specific complications associated with active endometriosis included severe hemorrhage, preeclampsia, sepsis, and intensive care unit admission, while inactive disease showed a weaker association. This paper is centrally about endometriosis — specifically its impact on obstetric outcomes and severe maternal morbidity.

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Abstract

OBJECTIVE: To evaluate the association between endometriosis and risk of severe maternal morbidity (SMM). METHODS: We conducted a population-based retrospective cohort study of 2,412,823 deliveries at hospitals in Quebec, Canada, between 1989 and 2019. The exposure was surgically confirmed endometriosis. Patients were classified as having active endometriosis during pregnancy, inactive endometriosis during pregnancy, a diagnosis of endometriosis postpregnancy, or no endometriosis. The outcome was SMM, including by a range of life-threatening maternal conditions during pregnancy or up to 42 days postdelivery. We computed rates of SMM and used log binomial regression to assess the association with endometriosis (risk ratio [RR]; 95% CI), adjusted for maternal characteristics. RESULTS: Severe maternal morbidity occurred in 46.2 of 1,000 patients with endometriosis, compared with 30.7 of 1,000 patients without endometriosis. Relative to no exposure, endometriosis was associated with 1.43 times the risk of SMM (95% CI 1.36-1.51). Patients with endometriosis that was active during pregnancy had a greater risk of SMM (RR 1.93; 95% CI 1.76-2.11). Active endometriosis was associated with the risk of severe preeclampsia and eclampsia, severe hemorrhage, hysterectomy, cardiac complications, embolism, shock, sepsis, and intensive care unit admission. Inactive endometriosis was less strongly associated with these outcomes. CONCLUSION: Pregnant patients with endometriosis, especially active endometriosis, have a greater risk of SMM and may benefit from closer follow-up to prevent severe complications of pregnancy.
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Objective

To evaluate the association between endometriosis and risk of severe maternal morbidity (SMM).

Methods

We conducted a population-based retrospective cohort study of 2,412,823 deliveries at hospitals in Quebec, Canada, between 1989 and 2019. The exposure was surgically confirmed endometriosis. Patients were classified as having active endometriosis during pregnancy, inactive endometriosis during pregnancy, a diagnosis of endometriosis postpregnancy, or no endometriosis. The outcome was SMM, including by a range of life-threatening maternal conditions during pregnancy or up to 42 days postdelivery. We computed rates of SMM and used log binomial regression to assess the association with endometriosis (risk ratio [RR]; 95% CI), adjusted for maternal characteristics.

Results

Severe maternal morbidity occurred in 46.2 of 1,000 patients with endometriosis, compared with 30.7 of 1,000 patients without endometriosis. Relative to no exposure, endometriosis was associated with 1.43 times the risk of SMM (95% CI 1.36–1.51). Patients with endometriosis that was active during pregnancy had a greater risk of SMM (RR 1.93; 95% CI 1.76–2.11). Active endometriosis was associated with the risk of severe preeclampsia and eclampsia, severe hemorrhage, hysterectomy, cardiac complications, embolism, shock, sepsis, and intensive care unit admission. Inactive endometriosis was less strongly associated with these outcomes.

Conclusion

Pregnant patients with endometriosis, especially active endometriosis, have a greater risk of SMM and may benefit from closer follow-up to prevent severe complications of pregnancy. Endometriosis is associated with an increased risk of severe maternal morbidity, including severe hemorrhage, sepsis, and other life-threatening events.

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Condition tags

endometriosis

MeSH descriptors

Pregnancy Complications Pregnancy Complications Pregnancy Complications Pregnancy Complications Pregnancy Complications Pregnancy Complications Pregnancy Complications Pregnancy Complications Pregnancy Complications Pregnancy Complications Pregnancy Complications Pregnancy Complications Pregnancy Complications Pregnancy Complications Pregnancy Complications Pregnancy Complications Pregnancy Complications Pregnancy Complications Pregnancy Complications Pregnancy Complications

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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