Šalamun Vesna, Riemma Gaetano, Sirc Tina, Vrtacnik Bokal Eda, Ban Frangež Helena
Department of Human Reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia.
Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy.
J Clin Med. 2024 Oct 7;13(19):5956. doi: 10.3390/jcm13195956.
Deep infiltrating endometriosis has been linked to worsened maternal and neonatal outcomes. However, reports regarding bowel endometriosis are still scanty. We aimed to evaluate pregnancy, delivery, and newborn adverse outcomes in women after laparoscopic-assisted surgery for bowel endometriosis. : A single-center retrospective cohort study was conducted at a tertiary-care university hospital. From January 2015 to December 2021, pregnant women who were diagnosed and treated for bowel endometriosis were matched using a 1:3 ratio with pregnant women with no history of endometriosis. Patients were matched using the Cox proportional hazards model to determine parity, age, BMI and gestational age-adjusted relative risk (aRR) with a 95% confidence interval (CI). Co-primary outcomes were the incidence of labor abnormalities and cesarean section (CS) rate. Co-secondary outcomes were incidence of complications related to pregnancy, delivery, and newborn. : A total of 71 pregnancies among women treated for bowel endometriosis and 213 from healthy controls were included. Patients requiring IVF/ET for getting pregnant were in the bowel endometriosis group relative to controls (43.7% vs. 11.7%; < 0.001). Increased risk of labor abnormalities was present for bowel endometriosis relative to controls (21.1% vs. 17.4%; = 0.040; aRR 1.39 [95% CI 1.06-2.05]). Risk of non-cephalic fetal presentation (14.1% vs. 6.1%; = 0.016; aRR 3.08 [95% CI 2.03-4.68]), CS rate (43.7% vs. 24.9%; = 0.003; aRR 1.75 [95% CI 1.23-2.49]), and emergent CS rate (19.7% vs. 8.5%; = 0.009; aRR 2.21 [95% CI 1.55-3.16]) were significantly higher in women treated for colorectal endometriosis compared with controls. Moreover, placenta previa (9.9% vs. 0.0%; < 0.001; aRR 21.82 [95% CI 2.19-116.40]), second-trimester hemorrhage (5.6% vs. 0.9%; = 0.017; aRR 6.00 [95% CI 1.12-32.06]), postpartum hemorrhage (15.5% vs. 3.3%; < 0.001; aRR 4.71 [95% CI 1.90-11.70]), and the need for transfusion during labor (5.6% vs. 0.5%; = 0.004; aRR 12.00 [95% CI 1.36-105.60]) were increased in treatments vs. controls. Concerning neonatal outcomes, an increased risk for neonatal intensive care unit admission was seen in postsurgical endometriotic women relative to healthy controls (26.0% vs. 6.9%; < 0.001; aRR 3.75 [2.04-3.86]). : Women treated for bowel endometriosis seem more exposed to adverse pregnancy and neonatal outcomes relative to healthy controls. However, additional prospective and comparative studies are needed to validate the available evidence.
深部浸润型子宫内膜异位症与孕产妇及新生儿不良结局相关。然而，关于肠道子宫内膜异位症的报道仍然较少。我们旨在评估接受肠道子宫内膜异位症腹腔镜辅助手术后女性的妊娠、分娩及新生儿不良结局。：在一家三级大学医院进行了一项单中心回顾性队列研究。2015年1月至2021年12月，将诊断并接受肠道子宫内膜异位症治疗的孕妇与无子宫内膜异位症病史的孕妇按1:3的比例进行匹配。使用Cox比例风险模型对患者进行匹配，以确定产次、年龄、体重指数和孕周调整后的相对风险（aRR）及95%置信区间（CI）。共同主要结局为产程异常发生率和剖宫产（CS）率。共同次要结局为与妊娠、分娩和新生儿相关的并发症发生率。：共纳入71例接受肠道子宫内膜异位症治疗的女性的妊娠病例和213例健康对照的妊娠病例。与对照组相比，肠道子宫内膜异位症组中需要体外受精/胚胎移植才能怀孕的患者比例更高（43.7%对11.7%；<0.001）。与对照组相比，肠道子宫内膜异位症患者产程异常风险增加（21.1%对17.4%；=0.040；aRR 1.39[95%CI 1.06 - 2.05]）。非头位胎儿先露风险（14.1%对6.1%；=0.016；aRR 3.08[95%CI 2.03 - 4.68]）、CS率（43.7%对24.9%；=0.003；aRR 1.75[95%CI 1.23 - 2.49]）和急诊CS率（19.7%对8.5%；=0.009；aRR 2.21[95%CI 1.55 - 3.16]）在接受结直肠子宫内膜异位症治疗的女性中显著高于对照组。此外，治疗组与对照组相比，前置胎盘（9.9%对0.0%；<0.001；aRR 21.82[95%CI 2.19 - 116.40]）、孕中期出血（5.6%对0.9%；=0.017；aRR 6.00[95%CI 1.12 - 32.06]）、产后出血（15.5%对3.3%；<0.001；aRR 4.71[95%CI 1.90 - 11.70]）以及分娩期间输血需求（5.6%对0.5%；=0.004；aRR 12.00[95%CI 1.36 - 105.60]）均增加。关于新生儿结局，与健康对照组相比，手术后患有子宫内膜异位症的女性新生儿入住新生儿重症监护病房的风险增加（26.0%对6.9%；<0.001；aRR 3.75[2.04 - 3.86]）。：与健康对照组相比，接受肠道子宫内膜异位症治疗的女性似乎更容易出现不良妊娠和新生儿结局。然而，需要更多的前瞻性和对比研究来验证现有证据。
