Management of endometriosis in a level 2B maternity unit: A retrospective study

Introduction: Endometriosis, a chronic gynecological conditio n, complicates fertility and pregnancy management, requiring tailored approaches in maternity units. This study evaluates the management of endometriosis in a level 2B maternity unit.

A retrospective study was conducted at Menzel Temime Regional Hospital, Tunisia, from January 2022 to December 2024, including 60 women with confirmed endometriosis managed during preconception or pregnancy. Data on demographics, clinical presentation, diagnostic methods, treatment strategies, and maternal-fetal outcomes were analyzed.

Mean age was 32.4 years; 70% had infertility history. Diagnosis was confirmed by laparoscopy (65%) or imaging (35%). Preconception management included hormonal therapy (50%) and assisted reproductive techniques (30%). During p regnancy, 40% required pain management, and 25% experienced complications (e.g., preterm labor). Live birth rate was 85%, with no significant maternal morbidity.

Effective endometriosis management in a level 2B maternity unit involves multidisc iplinary care, balancing hormonal, surgical, and obstetric interventions. Preconception optimization enhances pregnancy outcomes.

Endometriosis, maternity unit, pregnancy, fertility, multidisciplinary care 1. Introduction Endometriosis, characterized by ectopic endometrial tissue, affects 10 -15% of reproductive- age women, significantly impacting fertility and quality of life [1]. Symptoms include dysmenorrhea, chronic pelvic pain, and infertility, with 30 -50% of affected women ex - periencing conception difficulties [2]. In pregnancy, endometriosis may increase risks of preterm labor, placenta previa, and cesarean delivery [3]. Level 2B maternity units, equipped for moderate -risk pregnancies, face unique chal - lenges managing endometriosis due to limited specialized resources compared to level 3 units [4]. Effective management requires integrating gynecological, fertility, and obstetric care, often involving hormonal suppression, surgical intervention, or assisted reproductive technologies (ART) [5]. This study assesses the management strategies and outcomes of endometriosis in a level 2B maternity unit at Menzel Temime Regional Hospital, Tunisia, to inform best practices in similar settings. 2. Materials and Methods This retrospective study was c onducted at the Gynecology -Obstetrics Department of Menzel Temime Regional Hospital, a level 2B maternity unit in Tunisia, from January 1, 2022, to December 31, 2024. The study included 60 women with histologically or clinically confirmed endometriosis managed during preconception or pregnancy. Exclusion criteria were incomplete records or management exclusively outside the maternity unit. Data were collected from medical records, including demographics, endometriosis stage (American Society for Reproductiv e Medicine classification), diagnostic methods (laparoscopy, ultrasound, MRI), preconception treatments (hormonal, surgical, ART), pregnancy management (pain relief, monitoring), and maternal -fetal outcomes. Com - plications assessed included preterm labor (<37 weeks), placenta previa, and cesarean delivery. Descriptive statistics summarized patient characteristics (means ± SD for continuous variables, percentages for categorical). Chi-square tests compared categorical outcomes, and Student’s t- International Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com ~ 84 ~ test analy zed continuous variables. Statistical analysis used SPSS 25.0, with significance at p < 0.05. Ethical approval ensured data anonymity, with no conflicts of interest declared. 3. Results 3.1 Population Characteristics The cohort included 60 women with a me an age of 32.4 years (range: 24-41). Of these, 70% (42/60) had a history of infertility, and 55% (33/60) were primiparous. Endometriosis was staged as minimal/mild (stage I/II) in 45% (27/60) and moderate/severe (stage III/IV) in 55% (33/60) (Table 1). 3.2 Diagnostic Methods Diagnosis was confirmed by laparoscopy in 65% (39/60), ultrasound in 25% (15/60), and MRI in 10% (6/60). Ultrasound identified endometriomas in 80% of imaging -based diagnoses, with MRI used for deep infiltrating endometriosis (DIE). Preconception la - paroscopy was diagnostic and therapeutic in 50% (30/60), reducing pain and improving fertility (Table 2). Table 1: Demographic and Clinical Characteristics Characteristic Value Age (mean, years) 32.4 ± 4.8 BMI (mean, kg/m²) 25.6 ± 3.9 Primiparous 33 (55.0%) Infertility history 42 (70.0%) Endometriosis stage I/II 27 (45.0%) Endometriosis stage III/IV 33 (55.0%) Rural residence 38 (63.3%) Table 2: Diagnostic Methods

Frequency (%) Laparoscopy 39 (65.0) Ultrasound 15 (25.0) MRI 6 (10.0) Endometrioma (ultrasound) cases) 12 (80.0 of ultrasound Deep infiltrating endometriosis (MRI) 5 (83.3 of MRI cases) 3.3 Preconception Management Preconception treatment included hormonal therapy (combined oral contraceptives or progesti ns) in 50% (30/60), surgical resection of endometriomas or DIE in 35% (21/60), and ART (in vitro fertilization or intrauterine insemination) in 30% (18/60). ART was used in 42.9% (18/42) of infertility cases, with a 66.7% (12/18) conception rate (Table 3). Table 3: Preconception Management Strategies Treatment Frequency (%) Success Rate (%) Hormonal therapy 30 (50.0) 80.0 (pain reduction) Surgical resection 21 (35.0) 71.4 (fertility improvement) ART 18 (30.0) 66.7 (conception) No treatment 12 (20.0) - 3.4 Pregnancy Management During pregnancy, 40% (24/60) required pain management (paracetamol or low -dose NSAIDs), and 15% (9/60) used progestins for symptom control. Enhanced monitoring (biweekly ultrasounds) was implemented in 60% (36/60) due to stage III/IV disease or infertility history. Complications included preterm labor (15%, 9/60), placenta previa (5%, 3/60), and cesarean delivery (45%, 27/60) (Table 4). Table 4: Pregnancy Management and Complications Parameter Frequency (%) Pain management 24 (40.0) Progestin use 9 (15.0) Enhanced monitoring 36 (60.0) Preterm labor 9 (15.0) Placenta previa 3 (5.0) Cesarean delivery 27 (45.0) 3.5 Maternal-Fetal Outcomes Live birth rate was 85% (51/60), with 10% (6/60) spontaneous abortions and 5% (3/60) stillbirths. Mean gestational age at delivery was 37.8 weeks, with 12% (7/60) preterm births. Neonatal outcomes included a mean birthweight of 3,100 g and 8% (5/60) neonatal ICU admissions, primarily for prematurity. No significant maternal morbidity (e.g., severe hemorrhage) was reported, and 90% (54/60) resumed normal activities by 6 months postpartum (Table 5). Table 5: Maternal and Fetal Outcomes Outcome Frequency (%) Live births 51 (85.0) Spontaneous abortion 6 (10.0) Stillbirth 3 (5.0) Gestational age (mean, weeks) 37.8 ± 1.9 Preterm birth 7 (12.0) Birthweight (mean, g) 3,100 ± 450 Neonatal ICU admission 5 (8.0) Maternal morbidity (severe) 0 (0.0) Normal activity at 6 months 54 (90.0) 4. Discussion This study demonstrates effective manage ment of endometriosis in a level 2B maternity unit, achieving an 85% live birth rate despite a 70% infertility prevalence [1]. Laparoscopy was the primary diagnostic tool (65%), aligning with guidelines for its dual diagnostic - therapeutic role [5]. Ultras ound and MRI complemented diagnosis, particularly for endometriomas and DIE, consistent with reported sensitivities of 80-90% [4, 6]. Preconception hormonal therapy (50%) and surgery (35%) improved fertility and pain, supporting their use in optimizing pregnancy chances [2]. ART’s 66.7% success rate underscores its value for infertility [7]. In pregnancy, pain management (40%) and progestins (15%) controlled symptoms, though preterm labor (15%) and cesarean rates (45%) were elevated, corroborating increase d obstetric risks [3, 8] . The absence of severe maternal morbidity reflects coordinated care, despite limited resources [9].

include the retrospective design, small sample size, and lack of long- term follow-up. The level 2B setting may limit generalizability to higher -tier units with advanced surgical capabilities [10]. Future studies should explore minimally invasive techniques and cost-effectiveness in similar settings [11]. 5. Conclusion Managing endometriosis in a level 2B maternity unit r equires a multidisciplinary approach integrating preconception optimization, targeted pregnancy monitoring, and obstetric care. Hormonal therapy, surgery, and ART enhance fertility, while vigilant pregnancy management mitigates complications. These findings support feasible, effective care in moderate -resource settings, with further research needed to refine protocols. International Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com ~ 85 ~ Conflict of Interest Not available Financial Support Not available 6. References 1. Bulletti C, Coccia ME, Battistoni S, Borini A. Endometriosis and infertility. J Assist Reprod Genet. 2010;27(8):441-7. 2. de Ziegler D, Borghese B, Chapron C. Endometriosis and infertility: pathophysiology and management. Lancet. 2010;376(9742):730-8. 3. Leone Roberti Maggiore U, Ferrero S, Mangili G, Bergamini A, Inversetti A, Giorgione V, et al . Endometriosis and pregnancy outcome: a review. Arch Gynecol Obstet. 2014;289(6):1153-60. 4. Vercellini P, Viganò P, Somigliana E, Fedele L. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol. 2014;10(5):261-75. 5. Dunselman GA, Vermeulen N, Becker C, Calhaz -Jorge C, D’Hooghe T, De Bie B, et al . ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29(3):400-12. 6. Exacoustos C, Malzoni M, Di Giovanni A, Lazzeri L, Tosti C, Petraglia F, et al. Ultrasound diagnosis of endometriosis: accuracy and implications for clinical management. Ultrasound Obstet Gynecol. 2014;43(2):122-31. 7. Sallam HN. Endometriosis and assisted reproductive technologies. Reprod Biomed Online. 2008;17(Suppl 3):15 - 22. 8. Zullo F, Spagnolo E, Saccone G, Acunzo G, Xodo S, Ceccaroni M, et al . Endometriosis and obstetric complications: a systematic review and meta-analysis. Fertil Steril. 2017;108(4):667-72. 9. Johnson NP, Hummelshoj L, Adamson GD, Keckstein J, Taylor HS, Abrao MS, et al. World En dometriosis Society consensus on the classification of endometriosis. Hum Reprod. 2017;32(2):315-24. 10. Hornstein MD. Endometriosis: a review of current diagnostic and treatment options. Fertil Steril. 2018;110(4):630-7. 11. Berlanda N, Somigliana E, Vigano P. Ma nagement of endometriosis in women seeking fertility: a review. J Clin Med. 2019;8(10):1668. How to Cite This Article Hafsi M, Ragmoun H, Kristou E, Abaab A, Bezzine M. Management of endometriosis in a level 2B maternity unit: A retrospective study . International Journal of Clinical Obstetrics and Gynaecology . 2025;9(3):83-85. Creative Commons (CC) License This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution -NonCommercial-ShareAlike 4.0 International (CC BY -NC-SA 4.0) License, which allows others to remix, tweak, and build upon the work non -commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.