Department of Gynecology and Gynecological Oncology, University Hospital of Bern and University of Bern, Bern, Switzerland.
Department of Gynecology and Gynecological Oncology, University Hospital of Bern and University of Bern, Bern, Switzerland; Department of Gynecology, Obstetrics and Urology, "Sapienza" University of Rome, Rome, Italy.
Fertil Steril. 2018 Aug;110(3):459-466. doi: 10.1016/j.fertnstert.2018.04.036.
To study obstetric outcomes and complications in women with previously excised posterior deep infiltrating endometriosis (DIE) in comparison with women without endometriosis.
Matched case-control study.
Tertiary-level academic center.
PATIENT(S): All surgeries for endometriosis performed in the Department of Gynecology and Gynecological Oncology, University of Bern between March 2004 and July 2015, were assessed. Inclusion criteria included complete laparoscopic excision of posterior DIE. Exclusion criteria included concomitant hysterectomies, refusal to participate, and patients lost to follow-up. Each subsequent pregnancy was matched to three controls by maternal age, parity, history of cesarean, and mode of conception.
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): Obstetric complications.
RESULT(S): Among 841 patients with surgically diagnosed endometriosis, 125 satisfied the inclusion and exclusion criteria. Of these, 73 pregnancies resulted, although a further 11 patients were excluded owing to early miscarriages or extrauterine pregnancies. The final study cohort included 62 singleton pregnancies matched to 186 controls. The analysis identified an increased risk of placenta previa, gestational hypertension, and intrauterine growth restriction for the case group. The possibility of successful vaginal delivery was similar between groups. Moreover, no significant increase in risk of maternal and neonatal delivery complications, except for a slightly higher postpartum blood loss in the case group, was observed.
CONCLUSION(S): Despite previous surgical excision, women with history of DIE present a higher risk of placenta previa, gestational hypertonia, and intrauterine growth restriction during pregnancy. Previous surgery for DIE does not seem to predispose to failed vaginal delivery.
研究既往切除的深部浸润型子宫内膜异位症（DIE）女性的产科结局和并发症，并与无子宫内膜异位症的女性进行比较。
匹配病例对照研究。
三级学术中心。
评估了 2004 年 3 月至 2015 年 7 月期间在伯尔尼大学妇科和妇科肿瘤科进行的所有子宫内膜异位症手术。纳入标准包括完全腹腔镜切除后部 DIE。排除标准包括同时进行子宫切除术、拒绝参与以及随访丢失的患者。每位后续妊娠均通过产妇年龄、产次、剖宫产史和受孕方式与 3 名对照匹配。
无。
产科并发症。
在 841 例经手术诊断为子宫内膜异位症的患者中，有 125 例符合纳入和排除标准。其中，73 例妊娠，但由于早期流产或异位妊娠，又有 11 例被排除。最终研究队列纳入了 62 例单胎妊娠，与 186 例对照匹配。分析发现，病例组胎盘前置、妊娠高血压和宫内生长受限的风险增加。两组阴道分娩成功率相似。此外，除病例组产后出血量略高外，未观察到母体和新生儿分娩并发症的风险显著增加。
尽管有既往手术切除，但有深部浸润型子宫内膜异位症病史的女性在妊娠期间更易发生胎盘前置、妊娠高血压和宫内生长受限。深部浸润型子宫内膜异位症的既往手术似乎不会导致阴道分娩失败。
