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
