Comparaison des issues périnatales en cas d’endométriose colorectale entre les femmes avec antécédent de chirurgie complète et les femmes avec lésion in situ

Background: management of colorectal deep infiltrative endometriosis (CR-DIE) for women in reproductive age with pregnancy plan is debated. Surgical removal of the lesions remains technically challenging with possible severe complications and could be detrimental for ovarian reserve. Therefore, assisted reproductive technology (ART) could be proposed as a first line therapy for women with CR-DIE who desire to conceive. However, it is not clear if history of complete surgery for CR-DIE has consequence on pregnancy course and delivery. Objective: the aim of this study was to compare obstetrical concerns from women history of surgery for CR-DIE before pregnancy to women with CR-DIE in situ. Study design: this retrospective study at a referral center for endometriosis includes all pregnant women with CR-DIE from 2006 to 2016. In the history of surgery for CR-DIE group (HSCR-DIE group): all women had a colorectal resection with colorectal anastomosis and complete resection of extra-digestive lesion by the same team. Endometriosis was diagnosed histologically. In the in situ CR-DIE group (ISCR-DIE group): CR-DIE lesions were diagnosed at imaging using strict and standardized criteria. Outcomes were compared between women with operated CR-DIE before pregnancy and those with non-operated CR-DIE. The primary outcome measure was a composite criterion of obstetrical complication including at least one of the following: preterm delivery before 37 WG, preterm rupture of membrane before 37 WG, preeclampsia, and post-partum hemorrhage >500 ml. Results: of 104 pregnancies, 50 had history of surgery for CR-DIE and 54 had in situ CR-DIE. Nulliparity rate was 72.1%, and 48.1 % of pregnancies were obtained after assisted reproductive therapy. Mean gestational age at delivery was 38.1 ± 0.3 weeks of gestation and rate of C-section was 36.1 %. The composite maternal morbidity rate was not different between HSCR-DIE group than the ISCR-DIE group (16 (32.0%) vs. 16 (29.6%), P = 0.794). C section was performed nearly 2 time more frequently in the HSCR-DIE group than the ISCR-DIE group (46.0 % vs 27.8%, p = 0.05). Conclusion: obstetrical complication occurrence is not different according to history of colorectal resection / anastomosis before pregnancy in case of CR-DIE. C-section rate tends to be higher in the HSCR-DIE group than the ISCR-DIE group. Further studies are needed to delineate the right delivery course in case of CR-DIE.