Shmueli Anat, Salman Lina, Hiersch Liran, Ashwal Eran, Hadar Eran, Wiznitzer Arnon, Yogev Yariv, Aviram Amir
a Helen Schneider Hospital for Women, Rabin Medical Center , Petach Tikva , Israel.
b Sackler Faculty of Medicine , Tel Aviv University , Ramat Aviv , Israel.
J Matern Fetal Neonatal Med. 2019 Mar;32(5):845-850. doi: 10.1080/14767058.2017.1393513. Epub 2017 Oct 29.
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.
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.
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.
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.
子宫内膜异位症定义为子宫外存在类似子宫内膜的组织，伴有盆腔疼痛和生育力低下，影响0.6%-10%的普通女性人群。子宫内膜异位症与产科结局之间的关联尚未明确确立。我们旨在评估子宫内膜异位症是否与产科及新生儿并发症的发生率较高相关。
一项对一家大学附属三级医院（2007-2014年）所有分娩病例的回顾性队列研究。纳入标准仅限于先前诊断为子宫内膜异位症且为单胎妊娠的女性。诊断为结构或染色体异常的胎儿或新生儿被排除。我们比较了患有子宫内膜异位症的女性与未患子宫内膜异位症的女性的分娩过程及结局以及新生儿即时结局。
总体而言，61535例分娩符合分析条件，其中135例（0.002%）患有子宫内膜异位症。子宫内膜异位症组的女性具有产妇年龄较大、产次较低和初产率较高以及分娩时孕周较早的特点。患有子宫内膜异位症的女性引产失败率较高（调整后比值比5.2，95%置信区间1.8-14.9）、剖宫产率较高（调整后比值比5.0，95%置信区间3.3-7.4）、产后出血率较高（调整后比值比3.7，95%置信区间1.6-8.5）、胎盘植入率较高（调整后比值比6.24，95%置信区间2.20-17.67）、产后血红蛋白<10mg/dL（调整后比值比2.03，95%置信区间1.31-3.14）以及红细胞压积输血率较高（调整后比值比3.66，95%置信区间1.94-6.91）。未观察到新生儿结局的显著差异。
子宫内膜异位症与剖宫产和产后出血的较高风险相关。我们的研究结果表明，对于这些女性应考虑进行适当的分娩准备，如宫缩剂和血液制品。
