Leone Roberti Maggiore Umberto, Inversetti Annalisa, Schimberni Matteo, Viganò Paola, Giorgione Veronica, Candiani Massimo
Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, University of Genoa, Genoa, Italy; Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Fertil Steril. 2017 Dec;108(6):895-912. doi: 10.1016/j.fertnstert.2017.10.035.
Over the past few years, a new topic in the field of endometriosis has emerged: the potential impact of the disease on pregnancy outcomes. This review aims to summarize in detail the available evidence on the relationship between endometriosis, particularly deep endometriosis (DE), and obstetrical outcomes. Acute complications of DE, such as spontaneous hemoperitoneum, bowel perforation, and uterine rupture, may occur during pregnancy. Although these events represent life-threatening conditions, they are rare and unpredictable. Therefore, the current literature does not support any kind of prophylactic surgery before pregnancy to prevent such complications. Results on the impact of DE on obstetrical outcomes are debatable and characterized by several limitations, including small sample size, lack of adjustment for confounders, lack of adequate control subjects, and other methodologic flaws. For these reasons, it is not possible to draw conclusions on this topic. The strongest evidence shows that DE is associated with higher rates of placenta previa; for other obstetrical outcomes, such as miscarriage, intrauterine growth restriction, preterm birth and hypertensive disorders, results are controversial. Although it is unlikely that surgery of DE may modify the impact of the disease on the course of pregnancy, no study has yet investigated this issue.
在过去几年中，子宫内膜异位症领域出现了一个新话题：该疾病对妊娠结局的潜在影响。本综述旨在详细总结关于子宫内膜异位症，尤其是深部子宫内膜异位症（DE）与产科结局之间关系的现有证据。DE的急性并发症，如自发性腹腔内出血、肠穿孔和子宫破裂，可能在妊娠期间发生。尽管这些事件代表着危及生命的情况，但它们很少见且不可预测。因此，目前的文献不支持在妊娠前进行任何预防性手术以预防此类并发症。关于DE对产科结局影响的结果存在争议，且存在一些局限性，包括样本量小、未对混杂因素进行调整、缺乏足够的对照对象以及其他方法学缺陷。由于这些原因，无法就此话题得出结论。最有力的证据表明，DE与前置胎盘的发生率较高有关；对于其他产科结局，如流产、胎儿生长受限、早产和高血压疾病，结果存在争议。尽管DE手术不太可能改变该疾病对妊娠过程的影响，但尚未有研究对此问题进行调查。
