A Thomin1,2, J Belghiti1,2, C David3, O Marty1,2, M Bornes1,2, M Ballester1,2,4, H Roman5,6, E Daraï1,2,4. 1. Department of Gynaecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France. 2. GRC 6 UPMC (C3E) Centre Expert en Endométriose, Paris, France. 3. Department of Gynaecology and Obstetrics, Rouen University Hospital, Hospital-Charles Nicolle, Rouen, France. 4. UMRS938, Université Pierre et Marie Curie, Paris, France. 5. Department of Gynaecology and Obstetrics, Rouen University Hospital, Rouen, France. 6. Research Group 4308, Spermatogenesis and Gamete Quality, IHU Rouen Normandy, IFRMP23, Reproductive Biology Laboratory, Rouen University Hospital, Rouen, France.
Abstract
OBJECTIVE: To evaluate delivery and neonatal outcomes in women with resected or in situ bowel endometriosis. DESIGN: Retrospective cohort study. SETTING: France. POPULATION AND SAMPLE: Analysis of 72 pregnancies from 67 women followed for colorectal endometriosis from 2001 to 2014 in six centres including two university expert centres for endometriosis. METHODS: Univariate analysis of maternal and neonatal outcomes. MAIN OUTCOME MEASURES: Routes for delivery and rate of complications. RESULTS: The colorectal surgery group comprised 41 women and the in situ colorectal group, 26 women. Overall, half of the women underwent caesarean section. A high incidence of postoperative complications (39%) was observed after caesarean section with no difference between the groups. Surgical difficulties at newborn extraction (22%) and postoperative complications (39%) occurred more often in women with anterior deep infiltrating endometriosis (respectively 63 versus 11%, P = 0.007 and 67% versus 26%, P = 0.046) independently of prior surgery for endometriosis. In the remaining half, vaginal delivery required an operative procedure in 28% of the women with a significant increase in postpartum complications compared with those who did not require a procedure (P = 0.001). Overall, the incidence of postpartum complications was lower after vaginal delivery (14%) than after caesarean section (39%) (P = 0.03). CONCLUSION: Pregnant women with colorectal endometriosis, irrespective of prior surgery, should be informed of the high risk of delivery by caesarean section. Vaginal delivery is preferrable in this setting because of the lower incidence of postpartum complications. TWEETABLE ABSTRACT: Due to the incidence of postpartum complications whatever the route of delivery, women should receive level III maternal care.
OBJECTIVE: To evaluate delivery and neonatal outcomes in women with resected or in situ bowel endometriosis. DESIGN: Retrospective cohort study. SETTING: France. POPULATION AND SAMPLE: Analysis of 72 pregnancies from 67 women followed for colorectal endometriosis from 2001 to 2014 in six centres including two university expert centres for endometriosis. METHODS: Univariate analysis of maternal and neonatal outcomes. MAIN OUTCOME MEASURES: Routes for delivery and rate of complications. RESULTS: The colorectal surgery group comprised 41 women and the in situ colorectal group, 26 women. Overall, half of the women underwent caesarean section. A high incidence of postoperative complications (39%) was observed after caesarean section with no difference between the groups. Surgical difficulties at newborn extraction (22%) and postoperative complications (39%) occurred more often in women with anterior deep infiltrating endometriosis (respectively 63 versus 11%, P = 0.007 and 67% versus 26%, P = 0.046) independently of prior surgery for endometriosis. In the remaining half, vaginal delivery required an operative procedure in 28% of the women with a significant increase in postpartum complications compared with those who did not require a procedure (P = 0.001). Overall, the incidence of postpartum complications was lower after vaginal delivery (14%) than after caesarean section (39%) (P = 0.03). CONCLUSION: Pregnant women with colorectal endometriosis, irrespective of prior surgery, should be informed of the high risk of delivery by caesarean section. Vaginal delivery is preferrable in this setting because of the lower incidence of postpartum complications. TWEETABLE ABSTRACT: Due to the incidence of postpartum complications whatever the route of delivery, women should receive level III maternal care.