Pregnancy and delivery outcomes in women with rectovaginal endometriosis treated either conservatively or operatively

Anni Tuominen, Liisu Saavalainen, Aila Tiitinen, Oskari Heikinheimo, Päivi Härkki
Fertility and sterility · 2020 · vol. 115(2) , pp. 406–415 · doi:10.1016/j.fertnstert.2020.07.051 · PMID:33039131 · W3092257129
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Women with rectovaginal endometriosis had similar pregnancy and live-birth rates, along with comparable complication rates, whether treated conservatively or surgically.

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Abstract

ObjectiveTo study reproductive outcomes, and pregnancy and delivery complications after conservative or operative treatment of rectovaginal endometriosis during long-term follow-up.DesignRetrospective cohort study.SettingUniversity hospital.Patient(s)Women with rectovaginal endometriosis referred to hospital due to any indication from 2004 to 2013 (N = 543) who were treated initially either conservatively (group CONS, n = 183), or operatively (OPER, n = 360) either with resection of rectovaginal nodule (RVR, n = 192) or with concomitant bowel resection (BR, n = 132).Intervention(s)Conservative or operative management.Main Outcome Measure(s)Clinical pregnancy rate, live-birth rate, and assessment of the complications during pregnancy and delivery.Results(s)Between women in the CONS group or OPER group, no differences were found in either clinical pregnancy rate (56%, n = 102 vs. 50%, n = 181) or live-birth rate (48%, n = 87 vs. 42%, n = 153). Of the pregnancies, 64% (n = 65) and 49% (n = 89), respectively, started after medically assisted reproduction. No differences emerge in the subanalysis of women <40 years-old who wished to conceive. The most common pregnancy complication was preterm birth: 15% (n = 13) in the CONS group and 20% (n = 30) in the OPER group. The cesarean delivery rate also was high (46%, n = 40 vs. 49%, n = 76). Complications emerged in 21% (n = 10) versus 29% (n = 23) of vaginal deliveries and 45% (n = 18) versus 53% (n = 40) of cesarean deliveries. The most common delivery complication was excessive bleeding. The follow-up period was 4.9 years in the CONS group and 5.6 years in the OPER group.Conclusion(s)Women with rectovaginal endometriosis have comparable and good reproductive prognosis regardless of the treatment method. To study reproductive outcomes, and pregnancy and delivery complications after conservative or operative treatment of rectovaginal endometriosis during long-term follow-up. Retrospective cohort study. University hospital. Women with rectovaginal endometriosis referred to hospital due to any indication from 2004 to 2013 (N = 543) who were treated initially either conservatively (group CONS, n = 183), or operatively (OPER, n = 360) either with resection of rectovaginal nodule (RVR, n = 192) or with concomitant bowel resection (BR, n = 132). Conservative or operative management. Clinical pregnancy rate, live-birth rate, and assessment of the complications during pregnancy and delivery. Between women in the CONS group or OPER group, no differences were found in either clinical pregnancy rate (56%, n = 102 vs. 50%, n = 181) or live-birth rate (48%, n = 87 vs. 42%, n = 153). Of the pregnancies, 64% (n = 65) and 49% (n = 89), respectively, started after medically assisted reproduction. No differences emerge in the subanalysis of women <40 years-old who wished to conceive. The most common pregnancy complication was preterm birth: 15% (n = 13) in the CONS group and 20% (n = 30) in the OPER group. The cesarean delivery rate also was high (46%, n = 40 vs. 49%, n = 76). Complications emerged in 21% (n = 10) versus 29% (n = 23) of vaginal deliveries and 45% (n = 18) versus 53% (n = 40) of cesarean deliveries. The most common delivery complication was excessive bleeding. The follow-up period was 4.9 years in the CONS group and 5.6 years in the OPER group. Women with rectovaginal endometriosis have comparable and good reproductive prognosis regardless of the treatment method.

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Condition tags

endometriosisbowel_endometriosis

MeSH descriptors

Conservative Treatment Endometriosis Gynecologic Surgical Procedures Infertility, Female Rectum Vagina Adult Cohort Studies Conservative Treatment Conservative Treatment Endometriosis Endometriosis Endometriosis Female Follow-Up Studies Gynecologic Surgical Procedures Gynecologic Surgical Procedures Humans Infertility, Female Infertility, Female

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