Complications Of Endometriosis During Pregnancy Case Reports Of Life-Threating Events, Literature Anno 2018 And The Lack Of Well Designed Trials

PROBLEM STATEMENTu2022 Risks of complications associated with endometriosis during the pregnancy is clearlyunderestimated by most of the clinicians.u2022 Complete lack of large epidemiological studies quantifying the incidence of complications inthe population of pregnant women with endometriosis.u2022 These complications are rare but represent life-threating conditions, for both the mother andthe fetus, that mostly require surgical intervention (hemoperitoneum, bowel perforation, uterinerupture, placenta previa, perinatal deaths). Incidences remain clearly underestimated withmaximum values during second/third trimester but have been occasionally reported after birth.METHODSu2022 Retrospective review of 2 cases, in a period of 16 months, with strong similarities. Medicalrecord findings were summarized and compared.u2022 Published literature was reviewed using Pubmed, Cochrane Library and Up-to-date looking forthe words endometriosis, pregnancy, complications, life-threating.RESULTS:u2022 Number of publications: 142u2022 Reported complications:a) 39 hemoperitoneum (as consequence of vascular rupture or abnormal angiogenesis)b) 17 intestinal perforations (after endometriosis tissue invasion)c) 14 ruptures of endometriomasd) 10 acute appendicitis connected to appendiceal endometriosise) 2 uroperitoneumf) 2 distorsions of renal system anatomyg) 63 uterine ruptures (all of the reported cases underwent pelvic surgery)CONCLUSIONu2022 Complications of endometriosis during pregnancy are rare but life-threating conditionsu2022 Pathophysiological explanation remains hypothetical:1. endometriosis-related chronic inflammation: makes tissues and vessels more friable2. adhesions: increasing traction on surrounding structures when uterus is enlarging3. Invasion of healthy structures by decidualized endometriotic tissue with subsequentrisks of tissue rupture or haemorrhage.u2022 Strongest evidence: association between endometriosis and higher rates of placenta previa.u2022 Controversial: association with increased risk of miscarriage, intrauterine growth restriction,preterm birth and hypertensive disorders.u2022 No clear evidence for benefits of prophylactic surgery on maternal and fetal outcome.u2022 Need to correlate occurrence of obstetric complications with the stage of the disease in orderto identify patients with increased risks of severe complications.