Pregnancy and delivery complications in endometriosis

Shchegolev M.A., Tumanova U.N., Shchegolev A.I., Khilkevich E.G.

1) Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, Moscow, Russia; 2) Saint Alexis, Metropolitan of Moscow, Central Clinical Hospital, Moscow, Russia
The paper analyzes the data available in the literature on pregnancy and delivery complications in endometriosis. A high percentage of women with endometriosis experience infertility and have a higher risk of adverse pregnancy outcomes. Pregnant women with endometriosis are much more commonly noted to have placenta previa and placental abruption, preterm labor, to need a caesarean delivery, and to have gestational hypertension and preeclampsia, fetal death, and stillbirth. At the same time, the increased risk of pregnancy complications does not depend on the type of reproduction (spontaneous or using assisted reproductive technologies). The complicated course of pregnancy in women with endometriosis points to an interdisciplinary problem and justifies the need to follow up these patients in third-level healthcare facilities.
Conclusion: To prevent and minimize the risk of pregnancy complications, it is necessary to adhere to personalization tactics for both pregravid preparation and pregnancy management.

Authors’ contributions: Shchegolev M.A., Tumanova U.N. – literature data search and analysis, writing the text; Shchegolev A.I. – literature data analysis, editing the text; Khilkevich E.G. – design of the investigation, editing the text.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The investigation has not been sponsored.
For citation: Shchegolev M.A., Tumanova U.N., Shchegolev A.I., Khilkevich E.G.
Pregnancy and delivery complications in endometriosis.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (3): 5-12 (in Russian)
https://dx.doi.org/10.18565/aig.2022.322

Keywords

endometriosis
adenomyosis
pregnancy complications
placenta
fetal death
delivery

References

  1. Giudice L.C. Endometriosis. N. Engl. J. Med. 2010; 362(25): 2389-98.https://dx.doi.org/10.1056/NEJMcp1000274.
  2. Gylfason J.T., Kristjansson K.A., Sverrisdottir G., Jonsdottir K., Rafnsson V., Geirsson R.T. Pelvic endometriosis diagnosed in an entire nation over 20 years. Am. J. Epidemiol. 2010; 172(3): 237-43. https://dx.doi.org/10.1093/aje/kwq143.
  3. Parazzini F., Esposito G., Tozzi L., Noli S., Bianchi S. Epidemiology of endometriosis and its comorbidities. Eur. J. Obstet. Gynecol. Reprod. Biol. 2017; 209: 3-7. https://dx.doi.org/10.1016/j.ejogrb.2016.04.021.
  4. Kok V.C., Tsai H.J., Su C.F., Lee C.K. The risks for ovarian, endometrial, breast, colorectal, and other cancers in women with newly diagnosed endometriosis or adenomyosis: A population-based study. Int. J. Gynecol. Cancer. 2015; 25(6): 968-76. https://dx.doi.org/10.1097/IGC.0000000000000454.
  5. Щеголев А.И., Быков А.Г., Туманова У.Н., Павлович С.В. Эндометриоз и развитие опухолей. Акушерство и гинекология. 2016; 11: 49-56. [Shchegolev A.I., Bykov A.G., Tumanova U.N., Pavlovich S.V. Endometriosis and the development of tumors. Obstetrics and Gynegology. 2016; (11): 49-56. (in Russian)]. https://dx.doi.org/10.18565/aig.2016.11.49-56.
  6. Lee D., Kim S.K., Lee J.R., Jee B.C. Management of endometriosis-related infertility: Considerations and treatment options. Clin. Exp. Reprod. Med. 2020; 47(1): 1-11. https://dx.doi.org/10.5653/cerm.2019.02971.
  7. Prescott J., Farland L.V., Tobias D.K., Gaskins A.J., Spiegelman D., Chavarro J.E. et al. A prospective cohort study of endometriosis and subsequent risk of infertility. Hum. Reprod. 2016; 31(7): 1475-82. https://dx.doi.org/10.1093/humrep/dew085.
  8. Olive D.L., Stohs G.F., Metzger D.A., Franklin R.R. Expectant management and hydrotubations in the treatment of endometriosis-associated infertility. Fertil. Steril. 1985; 44(1): 35-41. https://dx.doi.org/10.1016/s0015-0282(16)48674-7.
  9. Campo S., Campo V., Benagiano G. Adenomyosis and infertility. Reprod. Biomed. Online. 2012; 24(1): 35-46. https://dx.doi.org/10.1016/j.rbmo.2011.10.003.
  10. Harada T., Taniguchi F., Amano H., Kurozawa Y., Ideno Y., Hayashi K. et al. Adverse obstetrical outcomes for women with endometriosis and adenomyosis: A large cohort of the Japan Environment and Children’s Study. PLoS One. 2019; 14(8): e0220256. https://dx.doi.org/10.1371/journal.pone.0220256.
  11. Santulli P., Lamau M.C., Marcellin L., Gayet V., Marzouk P., Borghese B. et al. Endometriosis-related infertility: ovarian endometrioma per se is not associated with presentation for infertility. Hum. Reprod. 2016; 31(8): 1765-75.https://dx.doi.org/10.1093/humrep/dew093.
  12. Туманова У.Н., Шувалова М.П., Щеголев А.И. Предлежание плаценты в генезе мертворождения (по данным Росстата в 2012-2016 годах). Международный журнал прикладных и фундаментальных исследований. 2018; 3: 81-5. [Tumanova U.N., Shuvalova M.P., Shchegolev A.I. Placenta previa in the genesis of stillbirth (according to Rosstat in 2012-2016). International Journal of Applied and Basic Research. 2018; (3): 81-5.(in Russian)]. https://dx.doi.org/10.17513/mjpfi.12153.
  13. Hashimoto A., Iriyama T., Sayama S., Nakayama T., Komatsu A.,Miyauchi A. et al. Adenomyosis and adverse perinatal outcomes: Increased risk of second trimester miscarriage, preeclampsia, and placental malposition. J. Matern. Fetal Neonatal Med. 2018; 31(3): 364-9. https://dx.doi.org/10.1080/14767058.2017.1285895.
  14. Lin H., Leng J.H., Liu J.T., Lang J.H. Obstetric outcomes in Chinese women with endometriosis: A retrospective cohort study. Chin. Med. J. 2015; 128(4): 455-8. https://dx.doi.org/10.4103/0366-6999.151077.
  15. Kmietowicz Z. Endometriosis is linked to greater risk of complications in pregnancy and birth, study finds. BMJ. 2015; 350: h3252.https://dx.doi.org/10.1136/bmj.h3252.
  16. Fujii T., Wada-Hiraike O., Nagamatsu T., Harada M., Hirata T., Koga K.et al. Assisted reproductive technology pregnancy complications are significantly associated with endometriosis severity before conception: A retrospective cohort study. Reprod. Biol. Endocrinol. 2016; 14(1): 73.https://dx.doi.org/10.1186/s12958-016-0209-2.
  17. Wang J.Q., Zhang J.M., Qian B. Adverse pregnancy outcomes for women with endometriosis: a systematic review and meta-analysis. Ginekol. Pol. 2021; Sep. 20. https://dx.doi.org/10.5603/GP.a2021.0081.
  18. Breintoft K., Pinnerup R., Henriksen T.B., Rytter D., Uldbjerg N., Forman A. et al. Endometriosis and risk of adverse pregnancy outcome: A systematic review and meta-analysis. J. Clin. Med. 2021; 10(4): 667. https://dx.doi.org/10.3390/jcm10040667.
  19. Vercellini P., Parazzini F., Pietropaolo G., Cipriani S., Frattaruolo M.P., Fedele L. Pregnancy outcome in women with peritoneal, ovarian and rectovaginal endometriosis: A retrospective cohort study. BJOG. 2012; 119(12): 1538-43. https://dx.doi.org/10.1111/j.1471-0528.2012.03466.x.
  20. Lalani S., Choudhry A.J., Firth B., Bacal V., Walker M., Wen S.W. et al. Endometriosis and adverse maternal, fetal and neonatal outcomes, a systematic review and meta-analysis. Hum. Reprod. 2018; 33(10): 1854-65.https://dx.doi.org/10.1093/humrep/dey269.
  21. Gasparri M.L., Nirgianakis K., Taghavi K., Papadia A., Mueller M.D. Placenta previa and placental abruption after assisted reproductive technology in patients with endometriosis: A systematic review and meta-analysis. Arch. Gynecol. Obstet. 2018; 298(1): 27-34. https://dx.doi.org/10.1007/s00404-018-4765-x.
  22. Takemura Y., Osuga Y., Fujimoto A., Oi N., Tsutsumi R., Koizumi M. et al. Increased risk of placenta previa is associated with endometriosis and tubal factor infertility in assisted reproductive technology pregnancy. Gynecol. Endocrinol. 2013; 29(2): 113-5. https://dx.doi.org/10.3109/09513590.2012.706669.
  23. Щеголев А.И., Туманова У.Н., Шувалова М.П. Преждевременная отслойка плаценты в генезе мертворождения. Международный журнал прикладных и фундаментальных исследований. 2016; 7-4: 575-9. [Shchegolev A.I., Tumanova U.N., Shuvalova M.P. Premature abruptio placentae as the cause of stillbirth. International Journal of Applied and Basic Research. 2016; (7-4): 575-9. (in Russian)].
  24. Туманова У.Н., Шувалова М.П., Щеголев А.И. Отслойка плаценты и ранняя неонатальная смертность (по данным Росстата в 2010-2016 годах). Международный журнал прикладных и фундаментальных исследований. 2018; 4: 86-90. [Tumanova U.N., Shuvalova M.P., Shchegolev A.I. Abruptio placentae and early neonatal mortality (according to Rosstat in 2012–2016). Journal of Applied and Basic Research. 2018; (4): 86-90.(in Russian)].
  25. Horton J., Sterrenburg M., Lane S., Maheshwari A., Li T.C., Cheong Y. Reproductive, obstetric, and perinatal outcomes of women with adenomyosis and endometriosis: A systematic review and meta-analysis. Hum. Reprod. Update. 2019; 25(5): 592-632. https://dx.doi.org/10.1093/humupd/dmz012.
  26. Exacoustos C., Lauriola I., Lazzeri L., De Felice G., Zupi E. Complications during pregnancy and delivery in women with untreated rectovaginal deep infiltrating endometriosis. Fertil. Steril. 2016, 106(5): 1129-35.https://dx.doi.org/10.1016/j.fertnstert.2016.06.024.
  27. Nirgianakis K., Gasparri M.L., Radan A.P., Villiger A., McKinnon B., Mosimann B. et al. Obstetric complications after laparoscopic excision of posterior deep infiltrating endometriosis: A case-control study. Fertil. Steril. 2018; 110(3): 459-66. https://dx.doi.org/10.1016/j.fertnstert.2018.04.036.
  28. Mercier F.J., Van de Velde M. Major obstetric hemorrhage. Anesthesiol. Clin. 2008; 26(1): 53-66. https://dx.doi.org/10.1016/j.anclin.2007.11.008.
  29. Healy D.L., Breheny S., Halliday J., Jaques A., Rushford D., Garrett C.et al. Prevalence and risk factors for obstetric haemorrhage in 6730 singleton births after assisted reproductive technology in Victoria Australia. Hum. Reprod. 2010; 25(1): 265-74. https://dx.doi.org/10.1093/humrep/dep376.
  30. Stephansson O., Kieler H., Granath F., Falconer H. Endometriosis, assisted reproduction technology, and risk of adverse pregnancy outcome. Hum. Reprod. 2009; 24(9): 2341-7. https://dx.doi.org/10.1093/humrep/dep186.
  31. Туманова У.Н., Шувалова М.П., Щеголев А.И. Преждевременный разрыв плодных оболочек и перинатальная смертность. Неонатология: новости, мнения, обучение. 2017; 1: 86-92. [Tumanova U.N., Shuvalova M.P., Shchegolev A.I. Premature rupture of membranes and perinatal death. Neonatology: News, Opinions, Training. 2017; (1): 86-92. (in Russian)].
  32. Conti N., Cevenini G., Vannuccini S., Orlandini C., Valensise H., Gervasi M.T. et al. Women with endometriosis at first pregnancy have an increased risk of adverse obstetric outcome. J. Matern. Fetal Neonatal Med. 2015; 28(15):1795-8. https://dx.doi.org/10.3109/14767058.2014.968843.
  33. Berlac J.F., Hartwell D., Skovlund C.W., Langhoff-Roos J., Lidegaard Ø. Endometriosis increases the risk of obstetrical and neonatal complications. Acta Obstet. Gynecol. Scand. 2017; 96(6): 751-60. https://dx.doi.org/10.1111/aogs.13111.
  34. Yamaguchi A., Kyozuka H., Fujimori K., Hosoya M., Yasumura S., Yokoyama T. et al. Risk of preterm birth, low birthweight and small-for-gestational-age infants in pregnancies with adenomyosis: A cohort study of the Japan Environment and Children’s Study. Acta Obstet. Gynecol. Scand. 2019; 98(3): 359-64.https://dx.doi.org/10.1111/aogs.13498.
  35. Zullo F., Spagnolo E., Saccone G., Acunzo M., Xodo S., Ceccaroni M. Endometriosis and obstetrics complications: A systematic review and meta-analysis. Fertil. Steril. 2017; 108(4): 667-72.e5. https://dx.doi.org/10.1016/j.fertnstert.2017.07.019.
  36. Vigano P., Corti L., Berlanda N. Beyond infertility: obstetrical and postpartum complications associated with endometriosis and adenomyosis. Fertil. Steril. 2015; 104(4): 802-12. https://dx.doi.org/10.1016/j.fertnstert.2015.08.030.
  37. Белоусов О.Г., Чайка В.К., Говоруха И.Т. Исходы беременности у женщин, страдающих генитальнгым эндометриозом. Медико-социальные проблемы семьи. 2020; 1: 5-14. [Belousov O.G., Chaika V.K., Govorukha I.T. Pregnancy outcomes in women suffering from genital endometriosis. Medical and Social Problems of the Family. 2020; (1): 5-14.(in Russian)].
  38. Shin Y.J., Kwak D.W., Chung J.H., Kim M.Y., Lee S.W., Han Y.J. The risk of preterm births among pregnant women with adenomyosis. J. Ultrasound Med. 2018; 37(8): 1937-43. https://dx.doi.org/10.1002/jum.14540.
  39. Villar J., Carroli G., Zavaleta N., Donner A., Wojdyla D.M., Faundes A. et al. Maternal and neonatal individual risks and benefits associated with caesarean delivery: Multicentre prospective study. BMJ. 2007; 335(7628): 1025.https://dx.doi.org/10.1136/bmj.39363.706956.55.
  40. WHO guidelines approved by the guidelines review committee. In WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia. Geneva: WHO; 2011.
  41. Туманова У.Н., Щеголев А.И. Артериальная гипертензия у беременных как фактор риска мертворождения (обзор литературы). Международный журнал прикладных и фундаментальных исследований. 2017; 8(ч.1): 78-82. [Tumanova U.N., Shchegolev A.I. Hypertensive disorders of pregnancy as the cause of stillbirth (review)). International Journal of Applied and Basic Research. 2017; 8(1): 78-82 (in Russian)].
  42. Kortelahti M., Anttila M.A., Hippeläinen M.I., Heinonen S.T. Obstetric outcome in women with endometriosis - A matched case control study. Gynecol. Obstet. Investig. 2003; 56(4): 207-12. https://dx.doi.org/10.1159/000074815.
  43. Stephansson O., Kieler H., Granath F., Falconer H. Endometriosis, assisted reproduction technology, and risk of adverse pregnancy outcome. Hum. Reprod. 2009; 24(9): 2341-7. https://dx.doi.org/10.1093/humrep/dep186.
  44. Lin H., Leng J.H., Liu J.T., Lang J.H. Obstetric outcomes in Chinese women with endometriosis: A retrospective cohort study. Chin. Med. J. 2015; 128(4): 455-8. https://dx.doi.org/10.4103/0366-6999.151077.
  45. Щеголев А.И., Туманова У.Н., Ляпин В.М., Серов В.Н. Синцитиотрофобласт ворсин плаценты в норме и при преэклампсии. Акушерство и гинекология. 2020; 6: 21-8. [Shchegolev A.I., Tumanova U.S., Lyapin V.M., Serov V.N. The syncytiotrophoblast of the placental villi in health and in preeclampsia. Obstetrics and Gynegology. 2020; (6): 21-8. (in Russian)].https://dx.doi.org/10.18565/aig.2020.6.21-28.
  46. Ходжаева З.С., Шмаков Р.Г., Коган Е.А., Щеголев А.И., Клименченко Н.И., Акатьева А.С., Вавина О.В., Воднева Д.Н., Романова В.В., Сухих Г.Т. Клинико-анамнестические особенности, плацента и плацентарная площадка при ранней и поздней преэклампсии. Акушерство и гинекология. 2015; 4; 25-31. [Khodzhaeva Z.S., Shmakov R.G., Kogan E.A., Shchegolev A.I., Klimenchenko N.I., Akatyeva A.S., Vavina O.V., Vodneva D.N., Romanova V.V., Sukhikh G.T. Clinical and anamnestic features, the placenta and placental bed in early and late preeclampsia.Obstetrics and Gynegology. 2015; (4); 25-31. (in Russian)].
  47. Shchyogolev A.I., Dubova E.A., Pavlov K.A., Lyapin V.M., Kulikova G.V., Shmakov R.G. Morphometric characteristics of terminal villi of the placenta in pre-eclampsia. Bull. Exp. Biol. Med. 2012; 154(1): 92-5.https://dx.doi.org/10.1007/s10517-012-1883-5.
  48. Huang Y., Zhao X., Chen Y., Wang J., Zheng W., Cao L. Miscarriage on endometriosis and adenomyosis in women by assisted reproductive technology or with spontaneous conception: A systematic review and meta-analysis. Biomed. Res. Int. 2020; 2020: 4381346. https://dx.doi.org/10.1155/2020/4381346.
  49. Aris A. A 12-year cohort study on adverse pregnancy outcomes in eastern townships of Canada: impact of endometriosis. Gynecol. Endocrinol. 2014; 30(1): 34-7. https://dx.doi.org/10.3109/09513590.2013.848425.
  50. Frincu F., Carp-Veliscu A., Petca A., Badiu D.-C., Bratila E., Cirstoiu M. et al. Maternal–fetal outcomes in women with endometriosis and shared pathogenic mechanisms. Medicina (Kaunas). 2021; 57(11): 1258.https://dx.doi.org/10.3390/medicina57111258.
  51. Мартынова Н.В., Липатов И.С., Тезиков Ю.В., Овчинникова М.А., Рябова С.А. Осложнения беременности и родов у женщин с генитальным эндометриозом. Современные проблемы науки и образования. 2017; 1: 28. [Martynova N.V., Lipatov I.S., Tezikov Y.V., Ovchinnikova M.A., Ryabova S.A. Complications of pregnancy and childbirth in women with genital endometriosis. Current Problems of Science and Education. 2017; (1): 28.(in Russian)].
  52. Ярмолинская М.И., Сейидова Ч.И. Влияние генитального эндометриоза на репродуктивную функцию и течение беременности. Журнал акушерства и женских болезней. 2020; 69(3): 47-56. [Yarmolinskaya M.I., Seyidova C.I. Effect of genital endometriosis on fertility and gestation course. Journal of Obstetrics and Women's Diseases. 2020; 69(3): 47-56. (in Russian)].https://dx.doi.org/10.17816/JOWD69347-56.
  53. Landi S., Mereu L., Pontrelli G., Stepniewska A., Romano L., Tateo S.et al. The influence of adenomyosis in patients laparoscopically treated for deep endometriosis. J. Minim. Invasive Gynecol. 2008; 15(5): 566-70.https://dx.doi.org/10.1016/j.jmig.2008.06.009.
  54. Brosens I., Brosens J.J., Fusi L., Al-Sabbagh M., Kuroda K., Benagiano G. Risks of adverse pregnancy outcome in endometriosis. Fertil. Steril. 2012; 98(1): 30-5. https://dx.doi.org/10.1016/j.fertnstert.2012.02.024.
  55. Juang C.M., Chou P., Yen M.S., Twu N.F., Horng H.C., Hsu W.L. Adenomyosis and risk of preterm delivery. Br. J. Obstet. Gynaecol. 2007; 114(2): 165-9. https://dx.doi.org/10.1111/j.1471-0528.2006.01186.x.
  56. Petraglia F., Arcuri F., de Ziegler D., Chapron C. Inflammation: a link between endometriosis and preterm birth. Fertil. Steril. 2012; 98(1): 36-40.https://dx.doi.org/10.1016/j.fertnstert.2012.04.051.

Received 30.12.2022

Accepted 20.02.2023

About the Authors

Mikhail A. Shchegolev, obstetrician-gynecologist at the gynecological center, Surgical Department, Central Clinical Hospital of St. Alexis,
119071, Russia, Moscow, Leninskiy Ave., 27.
Uliana N. Tumanova, Dr. Med. Sci., Leading Researcher at the 2nd Pathology Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, u.n.tumanova@gmail.com, https://orcid.org/0000-0002-0924-6555,
117997, Russia, Moscow, Oparina str., 4.
Alexander I. Shchegolev, Dr. Med. Sci., Professor, Head of the 2nd Pathology Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, ashegolev@oparina4.ru, https://orcid.org/0000-0002-2111-1530, 117997, Russia, Moscow, Oparina str., 4.
Elena G. Khilkevich, Dr. Med. Sci., obstetrician-gynecologist of the Surgery Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, +7(495)438-77-83, e_khilkevich@oparina4.ru, https://orcid.org/0000-0001-8826-8439,
117997, Russia, Moscow, Ac. Oparina str., 4.

Similar Articles

By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.