Anat Shmueli1,2, Lina Salman1,2, Liran Hiersch2,3, Eran Ashwal2,3, Eran Hadar1,2, Arnon Wiznitzer1,2, Yariv Yogev2,3, Amir Aviram2,3. 1. a Helen Schneider Hospital for Women, Rabin Medical Center , Petach Tikva , Israel. 2. b Sackler Faculty of Medicine , Tel Aviv University , Ramat Aviv , Israel. 3. c Lis Maternity and Women's Hospital , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel.
Abstract
OBJECTIVE: Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, associated with pelvic pain and subfertility, affecting 0.6-10% of the general female population. The association between endometriosis and obstetrical outcomes is not well established. We aimed to evaluate whether endometriosis is associated with a higher incidence of obstetrical and neonatal complications. STUDY DESIGN: A retrospective cohort study of all deliveries in a university-affiliated tertiary hospital (2007-2014). Eligibility was limited to women with previously diagnosed endometriosis and singleton pregnancies. Fetuses or neonates diagnosed with structural or chromosomal anomalies were excluded. We compared labor and delivery outcomes and immediate neonatal outcomes among women with endometriosis compared with women without endometriosis. RESULTS: Overall, 61,535 deliveries were eligible for analysis, of which 135 (0.002%) had endometriosis. Women with in the endometriosis group were characterized by higher maternal age, lower parity and higher nulliparity rate, and an earlier gestational age at delivery. Women with endometriosis had higher rate of failure of induction of labor (aOR 5.2, 95%CI 1.8-14.9), cesarean delivery (aOR 5.0, 95%CI 3.3-7.4), postpartum hemorrhage (aOR 3.7, 95%CI 1.6-8.5), placenta accreta (aOR 6.24, 95%CI 2.20-17.67), postpartum hemoglobin <10 mg/dL (aOR 2.03, 95%CI 1.31-3.14), and packed cell transfusion (aOR 3.66, 95%CI 1.94-6.91). No significant differences in neonatal outcomes were observed. CONCLUSIONS: Endometriosis is associated with higher risk of cesarean delivery and postpartum hemorrhage. Our findings suggest appropriate preparations for delivery, such as uterotonic agents and blood products, should be considered in these women.
OBJECTIVE:Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, associated with pelvic pain and subfertility, affecting 0.6-10% of the general female population. The association between endometriosis and obstetrical outcomes is not well established. We aimed to evaluate whether endometriosis is associated with a higher incidence of obstetrical and neonatal complications. STUDY DESIGN: A retrospective cohort study of all deliveries in a university-affiliated tertiary hospital (2007-2014). Eligibility was limited to women with previously diagnosed endometriosis and singleton pregnancies. Fetuses or neonates diagnosed with structural or chromosomal anomalies were excluded. We compared labor and delivery outcomes and immediate neonatal outcomes among women with endometriosis compared with women without endometriosis. RESULTS: Overall, 61,535 deliveries were eligible for analysis, of which 135 (0.002%) had endometriosis. Women with in the endometriosis group were characterized by higher maternal age, lower parity and higher nulliparity rate, and an earlier gestational age at delivery. Women with endometriosis had higher rate of failure of induction of labor (aOR 5.2, 95%CI 1.8-14.9), cesarean delivery (aOR 5.0, 95%CI 3.3-7.4), postpartum hemorrhage (aOR 3.7, 95%CI 1.6-8.5), placenta accreta (aOR 6.24, 95%CI 2.20-17.67), postpartum hemoglobin <10 mg/dL (aOR 2.03, 95%CI 1.31-3.14), and packed cell transfusion (aOR 3.66, 95%CI 1.94-6.91). No significant differences in neonatal outcomes were observed. CONCLUSIONS:Endometriosis is associated with higher risk of cesarean delivery and postpartum hemorrhage. Our findings suggest appropriate preparations for delivery, such as uterotonic agents and blood products, should be considered in these women.