REVIEW  INFERTILITY AND PREGNANCY OUTCOME 

Minerva Obstetrics and Gynecology 2022 February;74(1):31-44

DOI: 10.23736/S2724-606X.20.04718-8

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Endometriosis and adverse pregnancy outcome

Felice SORRENTINO ¹, Maristella DE PADOVA ¹, Maddalena FALAGARIO ¹, Maurizio N. D’ALTERI O ², Attilio DI SPIEZIO SARDO ³, Luis A. PACHECO ⁴, Jose T. CARUGNO ⁵, Luigi NAPPI ¹ ✉

¹ Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy; ² Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy; ³ School of Medicine, Department of Public Health, University of Naples Federico II, Naples, Italy; ⁴ Unit of Gynecologic Endoscopy, Gutenberg Center, Xanit International Hospital, Málaga, Spain; ⁵ Miller School of Medicine, Department of Obstetrics and Gynecology, University of Miami, Miami, FL, USA

INTRODUCTION: Endometriosis is a gynecologic disease affecting approximately 10% of reproductive age women, around 21-47% of women presenting subfertility and 71-87% of women with chronic pelvic pain. Main symptoms are chronic pelvic pain, dysmenorrhea, dyspareunia and infertility that seem to be well controlled by oral contraceptive pill, progestogens, GnRh antagonists. The aim of this review was to illustrate the modern diagnosis of endometriosis during pregnancy, to evaluate the evolution of endometriotic lesions during pregnancy and the incidence of adverse outcomes.
EVIDENCE ACQUISITION: Published literature was retrieved through searches of the database PubMed (National Center for Biotechnology Information, US National Library of Medicine, Bethesda, MD, USA). We searched for all original articles published in English through April 2020 and decided to extract every notable information for potential inclusion in this review. The search included the following MeSH search terms, alone or in combination: “endometriosis” combined with “endometrioma,” “biomarkers,” “complications,” “bowel,” “urinary tract,” “uterine rupture,” “spontaneous hemoperitoneum in pregnancy” and more “adverse pregnancy outcome,” “preterm birth,” “miscarriage,” “abruption placentae,” “placenta previa,” “hypertensive disorder,” “preeclampsia,” “fetal grow restriction,” “small for gestation age,” “cesarean delivery.”
EVIDENCE SYNTHESIS: Pregnancy in women with endometriosis does not always lead to disappearance of symptoms and decrease in the size of endometriotic lesions, but it may be possible to observe a malignant transformation of ovarian endometriotic lesions. Onset of complications may be caused by many factors: chronic inflammation, adhesions, progesterone resistance and a dysregulation of genes involved in the embryo implantation. As results, the pregnancy can be more difficult because of endometriosis related complications (spontaneous hemoperitoneum [SH], bowel complications, etc.) or adverse outcomes like preterm birth, FGR, hypertensive disorders, obstetrics hemorrhages (placenta previa, abruptio placenta), miscarriage or cesarean section. Due to insufficient knowledge about its pathogenesis, currently literature data are contradictory and do not show a strong correlation between endometriosis and these complications except for miscarriage and cesarean delivery,
CONCLUSIONS: Future research should focus on the potential biological pathways underlying these relationships in order to inform patients planning a birth about possible complications during pregnancy.

KEY WORDS: Endometriosis; Pregnancy; Abortion, spontaneous; Cesarean section