Women with endometriosis have higher odds of postpartum hemorrhage: Study
Endometriosis is a common gynecological condition and is
estimated to affect between 6% and 10% of women of reproductive age. The
prevalence of deep and ovarian endometriosis in pregnancy is approximately 5%,
which is similar to that of women attending a general gynecology clinic (6%),
and approximately 50% of women are unaware that they have this condition. There
is no consensus regarding specialist care for women with a diagnosis of
endometriosis during pregnancy; however, recent data suggest that endometriosis
may increase the risk of adverse obstetric and neonatal outcomes, including
preterm birth. Preterm birth, defined as birth at <37 ± 0
weeks of gestation, accounts for 7.4% of all live births in England and Wales.
It is the most important single determinant of adverse infant outcomes in terms
of both survival and quality of life and is the leading cause of perinatal
death and disability.
There is an urgent need for high-quality prospective
observational data to better define the obstetric risks for women with
endometriosis. The aim of this study by Elisabeth M. R. Bean et al was to
prospectively evaluate the relationship between pelvic endometriosis and
obstetric and neonatal outcomes in pregnant women who underwent screening for
endometriosis early in pregnancy.
This was a single-center, prospective cohort study of women
presenting to the Early Pregnancy Unit at University College London Hospital
(UCLH) between October 2017 and November 2019. Women were divided into
‘‘endometriosis’’ or ‘‘no endometriosis’’ groups, depending on whether they had
a diagnosis of pelvic endometriosis. Women with a live pregnancy progressing
beyond 12 weeks’ gestation who booked for antenatal care at University College
London Hospital were included in the study.
All women underwent a pelvic ultrasound examination in early
pregnancy to examine for the presence of endometriosis and uterine
abnormalities. Main outcome measures: The primary outcome of interest was
preterm birth, defined as delivery before 37 completed weeks’ gestation.
Secondary outcomes included late miscarriage, antepartum hemorrhage, placental
site disorders, gestational diabetes, hypertensive disorders of pregnancy,
neonates small for gestational age, mode of delivery, intrapartum sepsis,
postpartum hemorrhage, and admission to the neonatal unit.
Women with a diagnosis of endometriosis did not have
statistically significantly higher odds of preterm delivery (adjusted odds
ratio [aOR] 1.85 [95% confidence interval {CI} 0.50–6.90]), but they did have
higher odds of postpartum hemorrhage during cesarean section (aOR 3.64 [95% CI
2.07–6.35]) and admission of their newborn infant to the neonatal unit (aOR
3.24 [95% CI 1.089.73]). Women with persistent or recurrent deep endometriosis
after surgery also had higher odds of placental site disorders (aOR 8.65 [95%
CI 1.17–63.71]) and intrapartum sepsis (aOR 3.47 [95% CI 1.02–11.75]).
This study showed that most women with endometriosis do not
have statistically significantly higher odds of preterm delivery, irrespective
of their disease subtype. Women with endometriosis do appear to have higher
odds of excessive bleeding during CSs, and their newborn infants are more
likely to be admitted to the neonatal unit. Women with residual or recurrent
deep disease who have had previous surgery may have higher odds of adverse
outcomes, including placental site disorders and intrapartum sepsis.
This study did not identify endometriosis as a statistically
significant risk factor for preterm delivery and supports the European Society
of Human Reproduction and Embryology guidance that women with endometriosis do
not warrant increased antenatal care. There is no evidence to support routine
screening of women for the presence of endometriosis preconceptually or in
early pregnancy
Source: Elisabeth M. R. Bean, M.B.B.S., B.Sc.,a Jure Knez,
M.D.,b Nikolaos Thanatsis, M.D., Ph.D; Fertil Steril® Vol. 122, No. 4, October
2024 0015-0282
https://doi.org/10.1016/j.fertnstert.2024.05.162
