PREGNANCY AND OUTCOMES OF DELIVERY IN WOMEN WITH GENITAL ENDOMETRIOSIS

M. A. Pavlovskaya, Л. В. Гутикова, Yu. V. Kukharchyk
In: Journal of the Grodno State Medical University · 2020 · vol. 18(5) , pp. 569–574 · doi:10.25298/2221-8785-2020-18-5-569-574 · W3108769866
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This study analyzed pregnancy and delivery outcomes in 160 women with genital endometriosis, identifying critical gestational periods and frequent complications like miscarriage, placental disorders, hypoxia, and fetal growth retardation.

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The paper analyzed pregnancy course, delivery, and outcomes in 160 women who had been previously treated for genital endometriosis, compared with 50 healthy women with normally progressing pregnancies, using standard clinical, laboratory, and instrumental methods and statistical analysis with Statistica 10.0. In the endometriosis group, key “critical” gestational windows were reported at 6–12, 18–22, and 30–34 weeks, with complications including threatened early miscarriage (50%), placental dysfunction (65%), chronic fetal hypoxia (35%), fetal growth restriction (20%), and abnormal labor activity (60%). The main limitation is that the study focuses on women previously treated for genital endometriosis rather than treatment-naïve cases, and it does not provide further methodological details beyond the stated methods and analysis approach. This paper is centrally about endometriosis — it specifically examines pregnancy and delivery outcomes in women with genital endometriosis.

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Abstract

Background. The problem of genital endometriosis is relevant both in medical and in social aspects.Aim of the research. To analyze the course of pregnancy, childbirth and their outcomes in genital endometriosis to justify the critical terms of the complicated course of pregnancy and determine approaches for the development of therapeutic and preventive measures.Material and methods. The main group – 160 pregnant women, previously treated for genital endometriosis. The control group was 50 healthy women with a normal pregnancy. The generally accepted clinical laboratory and instrumental methods of the research were used. Statistical analysis of the data was carried out using the software package Statistica 10.0. Results. Gestational periods of 6-12 weeks, 18-22 weeks, 30-34 weeks of pregnancy are critical for women of the main group. The course of pregnancy is complicated by the threat of an early miscarriage (50%), placental disorders (65%), chronic hypoxia (35%) and fetal growth retardation (20%), anomalies of labor (60%).Conclusions. The complicated course of pregnancy in patients with genital endometriosis justifies the need to develop a comprehensive program for the prevention of gestational and perinatal complications.
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ТЕЧЕНИЕ БЕРЕМЕННОСТИ И ИСХОДЫ РОДОВ У ЖЕНЩИН С ГЕНИТАЛЬНЫМ ЭНДОМЕТРИОЗОМ Аннотация Введение. Проблема генитального эндометриоза актуальна как в медицинском, так и в социальном аспектах. Цель. Провести анализ течения беременности, родов, их исходов при генитальном эндометриозе для обоснования критических сроков осложненного течения беременности и определения подходов для разработки лечебно-профилактических мероприятий. Материал и методы. Основнкая группа – 160 беременных, ранее пролеченных по поводу генитального эндометриоза. Контрольная группа – 50 здоровых женщин с нормально протекающей беременностью. Использованы общепринятые клинико-лабораторные и инструментальные методы исследования. Статистический анализ данных проведен с использованием пакета прикладных программ Statistica 10.0. Результаты. Критические для женщин основной группы сроки гестации – 6-12 недель, 18-22 недели, 30-34 недели беременности. Течение беременности осложняется угрозой раннего выкидыша (50%), плацентарными нарушениями (65%), хронической гипоксией (35%) и задержкой роста плода (20%), аномалиями родовой деятельности (60%). Выводы. Осложненное течение беременности у пациентов с генитальным эндометриозом обосновывает необходимость разработки комплексной программы профилактики гестационных и перинатальных осложнений. Литература Juang CM, Chou P, Yen MS, Twu NF, Horng HC, Hsu WL. Adenomyosis and risk of preterm delivery. Br J Obstet Gynaecol. 2007;114(2):165-169. https://doi.org/10.1111/j.1471-0528.2006.01186.x Kortelahti M, Antilla MA, Hippelainen MI, Heinonen ST. Obstetric outcome in women with endometriosis - a matched case-control study. Gynecol Obstet Invest. 2003;56(4):207-212. https://doi.org/10.1159/000074815 Berlac JF, Hartwell D, Skovlund CW, Langhoff-Roos J, Lidegaard О. Endometriosis increases the risk of obstetric and neonatal complications. Acta Obstet Gynecol Scand. 2017;96(6):751-760. https://doi.org/10.1111/aogs.13111 Giudice LC, Evers JL, Healy DL, editors. Endometriosis: Science and Practice. Wley &Sons; 2012. 428 p. https://doi.org/10.1002/9781444398519 Basaran A. Can pregnancy impose a higher risk of perforation in patients with appendiceal endometriosis? Colorectal Dis. 2008;10:738. https://doi.org/10.1111/j.1463-1318.2008.01541.x Ueda Y, Enomoto T, Miyatake T, Fujita M, Yamamoto R, Kanagawa T, Shimizu H, Kimura T. A retrospective analysis of ovarian endometriosis during pregnancy. Fertil Steril. 2009;94(1):78-84. https://doi.org/10.1016/j.fertnstert.2009.02.092 Inoue T, Moriwaki T, Niki I. Endometriosis and spontaneous rupture of utero-ovarian vessels during pregnancy. Lancet. 1992;340(8813):240-241. https://doi.org/10.1016/0140-6736(92)90506-X Santos TMV, Pereira AMG, Lopes RGC, Depes Dde B. Lag time between onset of symptoms and diagnosis of endometriosis. Einstein. 2012;10(1):39-43. https://doi.org/10.1590/S1679-45082012000100009 Unanjan AL, Sidorova IS, Kogan EA, Belogubova SJu, Demura TA, Elisavetskaja AM, Sizova NM, Berlac JF. Jendometrioz, adenomioz, hronicheskij jendometrit: kliniko-patogeneticheskie vzaimootnoshenija i reproduktivnye neudachi [Еndometriosis, adenomyosis, chronic endometritis: clinical and pathogenetic relationships and reproductive failure]. Akusherstvo i ginekologija [Obstetrics and Gynecology]. 2018;10:136-140. https://doi.org/10.18565/aig.2018.10.136-140 (Russian). Matalliotakis I, Cakmak H, Dermitzaki D, Zervoudis S, Gou-menou A, Fragouli Y. Increased rate of endometriosis and spontaneous abortion in an in vitro fertilization program: no correlation with epidemiological factors. Gynecol. Endocrinol. 2008;24(4):194-198. https://doi.org/10.1080/09513590801948341 Leyendecker G, Kunz G, Herbertz M, Beil D, Huppert P, Mall G, Kissler S, Noe M, Wildt L. Uterine peristaltic activity and the development of endometriosis. Ann N Y Acad Sci. 2004;1034(1):338-355. https://doi.org/10.1196/annals.1335.036 Brosens IA, Fusi L, Brosens JJ. Endometriosis is a risk factor for spontaneous hemoperitoneum during pregnancy. Fertil Steril. 2009;92(4):1243-1245. https://doi.org/10.1016/j.fertnstert.2009.03.091 Benaglia L, Bermejo A, Somigliana E, Scarduelli C, Ragni G, Fedele L, Garcia-Velasco JA. Pregnancy outcome in women with endometriomas achieving pregnancy through IVF. Human Reproduction. 2012;27(6):1663-1667. https://doi.org/10.1007/978-4-431-54421-0_28 Zondervan KT, Cardon LR, Kennedy SH. What makes a good case-control study? Design issues for complex traits such as endometriosis. Hum Reprod. 2002;17(6):14151423. https://doi.org/10.1093/humrep/17.6.1415 Brosens I, Brosens JJ, Fusi L, Al-Sabbagh M, Kuroda K, Benagiano G. Risks of adverse pregnancy outcome in endometriosis. Fertil Steril. 2012;98(1):30-35. https://doi.org/10.1016/j.fertnstert.2012.02.024 Healy DL, Breheny S, Halliday J, Jaques A, Rushford D, Garrett C, Talbot JM, Baker HW. Prevalence and risk factors for obstetric haemorrhage in 6730 singleton births after assisted reproductive technology in Victoria Australia. Hum Reprod. 2010;25(1):265-274. https://doi.org/10.1093/humrep/dep376 Carvalho LFP, Rossener R, Azeem A, Malvezzi H, Simxes M, Agarwal AA. From conception to birth: how endometriosis affects the development of each stage of reproductive life. Мinerva ginecol. 2013;65(2):181-198. Ismail KM, Shervington J. Hemoperitoneum secondary to pelvic endometriosis in pregnancy. Int J Gynaecol Obstet. 1999;67:107-118. https://doi.org/10.1016/S0020-7292(99)00103-4

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