Department of Public Health, California State University-Fullerton, Fullerton, California.
Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, California.
Fertil Steril. 2023 Aug;120(2):360-368. doi: 10.1016/j.fertnstert.2023.03.033. Epub 2023 Apr 6.
To evaluate the association between endometriosis and the risk of severe maternal morbidity (SMM) as defined by the Centers for Disease Control and Prevention.
This was a population-based, retrospective cohort study using the California Office of Statewide Health Planning and Development Linked Birth File with hospital discharge International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnoses between 2007 and 2012.
Population-based.
PATIENT(S): A total of 3,098,578 pregnancies from 2007 to 2012.
INTERVENTION(S): Prior diagnosis of endometriosis identified using the ICD-9-CM codes 617.0-617.9.
MAIN OUTCOME MEASURE(S): The primary outcome of interest was SMM, which was defined as having been diagnosed with any of the ICD-9-CM codes corresponding to 25 peripartum conditions listed by the Centers for Disease Control and Prevention. The secondary outcomes of interest were each individual condition.
RESULT(S): Of the 3,098,578 pregnancies analyzed, 2,910 pregnancies were among women with a prior diagnosis of endometriosis. There were 45,655 pregnancies complicated by at least 1 SMM; 158 pregnancies (54.3 per 1,000 pregnancies) were in women with endometriosis and 45,497 (14.7 per 1,000 pregnancies) were in women without endometriosis. Women with pregnancies complicated by endometriosis were 2.41 times more likely to develop SMM than women who did not have endometriosis (adjusted odds ratio [aOR], 2.41; 95% confidence interval [CI], 2.03-2.87). There was an increased risk of disseminated intravascular coagulation (aOR, 2.46; 95% CI, 1.65-3.66), heart failure during a procedure or surgery (aOR, 2.58; 95% CI, 1.69-3.94), pulmonary edema (aOR, 3.02; 95% CI, 1.11-8.17), blood transfusion (aOR, 2.17; 95% CI, 1.75-2.68), and hysterectomy (aOR, 2.46; 95% CI, 1.58-3.85). When the association was stratified by delivery mode, the risk of SMM was higher for vaginal delivery (aOR, 4.59; 95% CI, 2.73-7.71) than for cesarean delivery (aOR, 1.64; 95% CI, 1.37-1.97) (P-interaction<.0001).
CONCLUSION(S): This study demonstrated that endometriosis is a major risk factor for SMM, especially among those who deliver vaginally. Furthermore, precautions should be taken before delivery in anticipation of potential complications.
评估子宫内膜异位症与疾病预防控制中心定义的严重产妇发病率（SMM）之间的关联。
这是一项基于人群的回顾性队列研究，使用加利福尼亚州全州卫生规划和发展办公室的出生档案与 2007 年至 2012 年之间的医院出院国际疾病分类，第 9 次修订版，临床修正（ICD-9-CM）诊断。
基于人群。
2007 年至 2012 年期间的 3,098,578 例妊娠。
使用 ICD-9-CM 代码 617.0-617.9 预先诊断子宫内膜异位症。
主要研究结果为 SMM，其定义为患有疾病预防控制中心列出的 25 种围产期疾病之一的任何 ICD-9-CM 代码。次要观察结果是每个单独的条件。
在分析的 3,098,578 例妊娠中，有 2,910 例是有子宫内膜异位症病史的女性。有 45,655 例妊娠至少并发 1 种 SMM；158 例（每 1,000 例妊娠中有 54.3 例）发生在有子宫内膜异位症的女性中，45,497 例（每 1,000 例妊娠中有 14.7 例）发生在没有子宫内膜异位症的女性中。患有子宫内膜异位症的妊娠女性发生 SMM 的可能性是没有子宫内膜异位症的女性的 2.41 倍（调整后的优势比[aOR]，2.41；95%置信区间[CI]，2.03-2.87）。弥散性血管内凝血（aOR，2.46；95%CI，1.65-3.66）、手术或手术期间心力衰竭（aOR，2.58；95%CI，1.69-3.94）、肺水肿（aOR，3.02；95%CI，1.11-8.17）、输血（aOR，2.17；95%CI，1.75-2.68）和子宫切除术（aOR，2.46；95%CI，1.58-3.85）的风险增加。当按分娩方式分层关联时，阴道分娩（aOR，4.59；95%CI，2.73-7.71）的 SMM 风险高于剖宫产（aOR，1.64；95%CI，1.37-1.97）（P 交互<.0001）。
本研究表明，子宫内膜异位症是 SMM 的主要危险因素，尤其是在阴道分娩的女性中。此外，应在分娩前采取预防措施，以应对潜在的并发症。
