Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Laboratory of Bell Research Center-Department of Obstetrics and Gynecology collaborative research, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
BMC Pregnancy Childbirth. 2019 Oct 22;19(1):373. doi: 10.1186/s12884-019-2514-1.
Endometriosis is a common disease occurring in 1-2% of all women of reproductive age. Although there is increasing evidence on the association between endometriosis and adverse perinatal outcomes, little is known about the effect of pre-pregnancy treatments for endometriosis on subsequent perinatal outcomes. Thus, this study aimed to evaluate maternal and neonatal outcomes in pregnant women with endometriosis and to investigate whether pre-pregnancy surgical treatment would affect these outcomes.
This case-control study included 2769 patients who gave birth at Nagoya University Hospital located in Japan between 2010 and 2017. Maternal and neonatal outcomes were compared between the endometriosis group (n = 80) and the control group (n = 2689). The endometriosis group was further divided into two groups: patients with a history of surgical treatment such as cystectomy for ovarian endometriosis, ablation or excision of endometriotic implants, or adhesiolysis (surgical treatment group, n = 49) and those treated with only medications or without any treatment (non-surgical treatment group, n = 31).
In the univariate analysis, placenta previa and postpartum hemorrhage were significantly increased in the endometriosis group compared to the control group (12.5% vs. 4.1%, p < 0.01 and 27.5% vs. 18.2%, p = 0.04, respectively). In the multivariate analysis, endometriosis significantly increased the odds ratio (OR) for placenta previa (adjusted OR, 3.19; 95% confidence interval [CI], 1.56-6.50, p < 0.01) but not for postpartum hemorrhage (adjusted OR, 1.14; 95% CI, 0.66-1.98, p = 0.64). Other maternal and neonatal outcomes were similar between the two groups. In patients with endometriosis, patients in the surgical treatment group were significantly associated with an increased risk of placenta previa (OR. 4.62; 95% CI, 2.11-10.10, p < 0.01); however, patients in the non-surgical treatment group were not associated with a high risk (OR, 1.63; 95% CI, 0.19-6.59, p = 0.36). Additionally, other maternal and neonatal outcomes were similar between the two groups.
Women who have had surgical treatment for their endometriosis appear to have a higher risk for placenta previa. This may be due to the more severe stage of endometriosis often found in these patients. However, clinicians should be alert to this potential increased risk and manage these patients accordingly.
子宫内膜异位症是一种常见疾病，在所有育龄妇女中发病率为 1-2%。尽管越来越多的证据表明子宫内膜异位症与不良围产结局之间存在关联，但对于子宫内膜异位症的孕前治疗对随后围产结局的影响知之甚少。因此，本研究旨在评估患有子宫内膜异位症的孕妇的母婴结局，并探讨孕前手术治疗是否会影响这些结局。
本病例对照研究纳入了 2010 年至 2017 年在日本名古屋大学医院分娩的 2769 名患者。比较了子宫内膜异位症组（n=80）和对照组（n=2689 名）的母婴结局。子宫内膜异位症组进一步分为两组：既往接受过卵巢子宫内膜异位囊肿切除术、子宫内膜异位灶切除术或粘连松解术等手术治疗的患者（手术治疗组，n=49）和仅接受药物治疗或未接受任何治疗的患者（非手术治疗组，n=31）。
单因素分析显示，与对照组相比，子宫内膜异位症组的胎盘前置和产后出血的发生率显著增加（12.5% vs. 4.1%，p<0.01 和 27.5% vs. 18.2%，p=0.04）。多因素分析显示，子宫内膜异位症显著增加了胎盘前置的优势比（调整后的 OR，3.19；95%置信区间 [CI]，1.56-6.50，p<0.01），但不增加产后出血的优势比（调整后的 OR，1.14；95% CI，0.66-1.98，p=0.64）。两组的其他母婴结局相似。在患有子宫内膜异位症的患者中，手术治疗组患者的胎盘前置风险显著增加（OR，4.62；95% CI，2.11-10.10，p<0.01）；然而，非手术治疗组患者的胎盘前置风险并未显著增加（OR，1.63；95% CI，0.19-6.59，p=0.36）。此外，两组的其他母婴结局相似。
接受过子宫内膜异位症手术治疗的女性似乎有更高的胎盘前置风险。这可能是由于这些患者中子宫内膜异位症的严重程度更高。然而，临床医生应警惕这种潜在的风险增加，并相应地管理这些患者。
