Department of Gynaecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
GRC 6 UPMC (C3E) Centre Expert en Endométriose, Paris, France.
BJOG. 2018 May;125(6):711-718. doi: 10.1111/1471-0528.14221. Epub 2016 Jul 18.
To evaluate delivery and neonatal outcomes in women with resected or in situ bowel endometriosis.
Retrospective cohort study.
France.
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.
Univariate analysis of maternal and neonatal outcomes.
Routes for delivery and rate of complications.
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).
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.
Due to the incidence of postpartum complications whatever the route of delivery, women should receive level III maternal care.
评估经直肠或原位肠子宫内膜异位症患者的分娩和新生儿结局。
回顾性队列研究。
法国。
分析了 2001 年至 2014 年在六个中心（包括两个子宫内膜异位症专家中心）对 67 名患有结直肠子宫内膜异位症的妇女进行的 72 例妊娠，其中 41 名妇女接受了直肠手术，26 名妇女为原位直肠。
对母婴结局进行单因素分析。
分娩方式和并发症发生率。
直肠手术组有 41 名妇女，原位直肠组有 26 名妇女。总体而言，有一半的妇女行剖宫产术。剖宫产术后并发症发生率较高（39%），但两组间无差异。在前深部浸润性子宫内膜异位症患者中，新生儿取出时手术困难（22%）和术后并发症（39%）更为常见（分别为 63%与 11%，P=0.007 和 67%与 26%，P=0.046），与子宫内膜异位症手术无关。在其余的一半患者中，28%需要手术的阴道分娩患者与不需要手术的患者相比，产后并发症明显增加（P=0.001）。总体而言，阴道分娩的产后并发症发生率（14%）低于剖宫产术（39%）（P=0.03）。
无论是否有先前的手术，患有结直肠子宫内膜异位症的孕妇都应被告知剖宫产的高风险。在这种情况下，阴道分娩更可取，因为产后并发症的发生率较低。
无论分娩方式如何，由于产后并发症的发生率，女性都应接受 III 级母婴保健。
