Impact of Endometriosis on Pregnancy and Delivery – a Retrospective Cohort Study

Sebastian Daniel Schäfer, Moritz Berkenkamp, Martin Götte, Ralf Schmitz, Ludwig Kiesel
In: Research Square · 2021 · doi:10.21203/rs.3.rs-297650/v1 · W3210334916
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Abstract

Abstract Purpose: The aim of the study was to assess the impact of endometriosis on subsequent pregnancy and delivery. Methods: retrospective analysis by questionnaire / interview of cases (endometriosis laparoscopically removed / child wish) vs. controls (endometriosis laparoscopically excluded / child wish) from the University Hospital Muenster, Germany, treated between 2009 and 2016; analysis of pregnancy rate, mode of delivery and complications using Clavien-Dindo-classification, role of deep infiltrating endometriosis using ENZIAN classification; data analysis using t-test with p < 0.050% being considered significant. Results: Identification of 973 consecutive cases vs 789 consecutive controls; inclusion of 501 cases: (pregnancy rate 57.5%) and 219 controls (pregnancy rate 60.7%). Primary cesarean section: trend to more in controls (p=0.202). Secondary cesarean section: trend to more in cases (p=0.111). Miscarriage: more in controls (p=0.038). DIE with risks equal to other types of endometriosis. Adenomyosis and bladder endometriosis: increased risk of secondary cesarean section. Pregnancy: more bleeding (p=0.005), early uterine contractions (p=0.012), cervical insufficiency (p=0.042), slightly more pre-eclampsia (p=0.080), amniorrhexis (p=0.220). Delivery: more bleeding (p=0.007), vaginal tear (p=0.009), symphysis diastasis (p=0.022), less episiotomy (p=0.002), prolonged labour (p=0.011). Puerperium: more bleeding (p=0.022), infectious complications p=0.007). Complications more in cases (Clavien Dindo I (p=0.005) or II (p=0.010); controls slightly more III (p=0.055)). Cases vs published control groups from general population: more placenta praevia (p=0.042), placental abruption, miscarriage (p<0.001; relative risk 2.23 (1.84-2.70)), delivery by cesarean section (p<0.001). Conclusion: Complications during pregnancy, delivery and puerperium occur more frequently in cases. The risk of miscarriage and delivery by cesarean section is increased. Endometriosis patients should receive counselling with regard to pregnancy and delivery. They should have access to specialized centers of care. Recommendations regarding mode of delivery should not exclude vaginal delivery also in cases of deep infiltrating endometriosis

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Outcome instruments

Enzian

Condition tags

endometriosisadenomyosisdie_deep_infiltratingbladder_endometriosis

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References (19)

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