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Impact of Endometriosis on Pregnancy and Delivery- A Retrospective Cohort Study

Author(s): Sebastian D Schäfer, Moritz Berkenkamp, Martin Götte, Ralf Schmitz, Ludwig Kiesel

Objective: To clarify if endometriosis, especially deep infiltrating endometriosis (DE), in our cohort is associated with increased risk of obstetric complications.

Material and Methods: Single center, retrospective analysis of consecutive cases (endometriosis laparoscopically removed and child wish) vs. consecutive controls (endometriosis laparoscopically excluded and child wish), from 2009 until 2016. Calculation of pregnancy rate. Analysis of mode of delivery and complications using Clavien-Dindo-classification. Analysis of DE using ENZIAN classification. Comparison also with controls from the literature. Statistical analysis: t-test (p < 0.050) and 95% Confidence Interval (CI).

Results: Inclusion of 501 out of 973 cases vs. 291 out of 789 controls. Pregnancy rate: cases 57.5% vs. controls 60.7%. Vaginal delivery: more in cases if natural conception (62% vs. 46.7% if ART, p=0.009). Cesarean section: if pregnancy by ART more secondary Cesarean section in cases (32% vs 20.8%; p=0.040). Miscarriage: more in controls (34.9% vs 27.6%; p=0.038). Complications: Clavien Dindo I and II more in cases (I: 43.3% vs. 32.5%, p=0.005; II: 29.7% vs. 21.0%, p=0.010). Clavien Dindo III and IV not increased. During pregnancy: more bleeding (p=0.005), early uterine contractions (p=0.012), cervical insufficiency (p=0.042), and tendency to more pre-eclampsia (p=0.080) in cases. During delivery: more bleeding (p=0.007), vaginal tear (p=0.009), pubic diastasis (p=0.022), prolonged labor (p=0.011), less episiotomy (p=0.002) in cases. During puerperium: more bleeding (p=0.022), infectious complications (p=0.007) in cases. DE: more cases of severe bleeding and abnormal cardiotocography leading to secondary caesarean section. Adenomyosis: slightly increased risk of secondary cesarean section (38.6% vs 27.7%, p=0.1). Cases vs control groups from the literature: more placenta praevia (p=0.042), placental abruption and miscarriage (p<0.001; relative risk 2.23 (1.84-2.70)), cesarean section (p<0.001).

Conclusion: Endometriosis is associated with an increase in obstetric complications. DE does not increase risks additionally. Mode of delivery should not exclude vaginal delivery per se.

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