Obstetric Outcome After Surgical Treatment of Endometriosis: A Review of the Literature

Samantha Mooney, Samantha S Mooney, Vanessa Ross, Catharyn Stern, Peter A W Rogers, Martin Healey
Frontiers in reproductive health · 2021 · vol. 3 , pp. 750750 · doi:10.3389/frph.2021.750750 · PMID:36303984 · PMC9580797 · W4200487754
review OA: gold CC0 ⤵ 6 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This review found insufficient evidence to conclude whether pre-pregnancy surgical treatment of endometriosis impacts future obstetric outcomes, citing a lack of high-quality studies.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This paper is a systematic review of studies (published 2015–June 2021) that compared obstetric outcomes after pre-pregnancy surgery for endometriosis versus pregnancy with unresected endometriosis in women followed beyond 20 weeks’ gestation. A Medline/Embase/PubMed search identified only three eligible studies, which were heterogeneous in design and outcome definitions and were judged to have critical risk of bias. Across studies, pre-pregnancy excision/ablation of endometriosis was associated with increased risks of some adverse outcomes in individual analyses, including caesarean section (one study), placenta praevia (one study), and several complications such as preterm birth, small for gestational age, gestational hypertension, and antepartum/postpartum haemorrhage (one study), but the overall evidence was insufficient to draw reliable conclusions. The paper explicitly notes a key limitation of inadequate evidence and calls for prospective studies accounting for confounders such as comorbid adenomyosis and infertility. This paper is centrally about endometriosis — it reviews whether pre-pregnancy surgical treatment of endometriosis affects subsequent obstetric outcomes.

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Abstract

A diagnosis of endometriosis is associated with increased risks of adverse pregnancy outcomes including placenta praevia and preterm birth. Some studies have also suggested associations with gestational hypertension, foetal growth restriction, gestational diabetes, perinatal death, and obstetric haemorrhage. This review aims to assess the impact of pre-pregnancy surgical treatment of endometriosis on future obstetric outcomes. A search of the Medline, Embase and PubMed electronic databases was performed to identify studies reporting pre-pregnancy surgery for endometriosis and subsequent pregnancy outcome compared to controls with unresected endometriosis. Three studies met the inclusion criteria. The studies were heterogenous in design, definition of study groups and outcome measures. All three studies were judged at critical risk of bias. Pre-pregnancy excision of endometriosis was associated with an increased risk of caesarean section in one of two studies, OR 1.72 (95% CI 1.59–1.86) and OR 1.79 (95% CI 0.69–4.64). Placenta praevia rates were also increased in one of two studies OR 2.83 (95% CI 0.56–12.31) and OR 2.04 (95% CI 1.66–2.52). One study found increased risks of preterm birth, small for gestational age, gestational hypertension, and antepartum and postpartum haemorrhage (all p < 0.05) with pre-pregnancy excision of endometriosis. There is insufficient evidence examining the role of pre-pregnancy endometriosis surgery in ameliorating adverse pregnancy outcomes, and thus reliable conclusions cannot be drawn. Prospectively designed studies are needed to assess the relationship between surgical treatments for endometriosis and obstetric outcome and examine potential confounders such as comorbid adenomyosis and infertility.

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endometriosisadenomyosisinfertility

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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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