Obstetric and perinatal outcomes in women with endometriosis

M R C O G PA R T 2 · S O S P O C K E T C A R D · K N O W L E D G E A R E A 5 – A N T E N ATA L C A R E

Obstetric and Perinatal Outcomes in Women with Endometriosis Rafi J et al. Obstetric and perinatal outcomes in women with endometriosis. TOG 2022;24:242–250. doi:10.1111/tog.12831

10% OR 3.17 1:10,000 WOMEN AFFECTED BY ENDOMETRIOSIS PLACENTA PRAEVIA RISK SHIP INCIDENCE IN PREGNANCY

DO N' T-M IS S FA C TS

1. HRE = adenomyosis, ART conception, or surgically treated peritoneal/deep infiltrating endometriosis – manage in consultant-led high-risk clinic; no national/international guidance exists

2. Placenta praevia: endometriosis OR 3.17; ART OR 5.6; combined OR 2.96; rectovaginal disease 7.6% vs peritoneal/ovarian 2.4%

3. SHiP: incidence 1:10,000; endometriosis in 19–55.9% of cases; fetal mortality 31%; diagnosis usually at laparotomy; can recur as late as day 9 postpartum

4. PET association remains unproven/inconsistent across meta-analyses – do not overstate this link

5. Caesarean section OR 1.31; highest with rectovaginal disease (42.9%)

6. Fetal/neonatal risk (Lalani ORs): PPROM 2.33, preterm birth 1.70, SGA 1.28, stillbirth 1.29, neonatal death MOR 1.78

7. ART + endometriosis: >3× placenta praevia, 2× caesarean, +87% abruption, +38% preterm delivery

8. Ensure IV access, blood availability, continuous CTG for HRE labours; active 3rd-stage management reduces PPH/anaemia

CONVINCING VS UNCERTAIN ASSOCIATIONS

Convincing: miscarriage, preterm birth, SGA, placenta praevia, PPH, caesarean

Uncertain/conflicting: PET & gestational hypertension

ABBREVIATION KEY

ART — assisted reproductive technology PET — pre-eclampsia

CI — confidence interval PGE2/PGF2α — prostaglandin E2/F2-alpha

DIE — deep infiltrating endometriosis PIH — pregnancy-induced hypertension

FBC — full blood count PPH — postpartum haemorrhage

GDM — gestational diabetes mellitus PPROM — preterm premature rupture of membranes

HRE — high-risk endometriosis PR-A/PR-B — progesterone receptor isoforms A/B

LRE — low-risk endometriosis PTD — preterm delivery

MDT — multidisciplinary team ROS — reactive oxygen species

MOR — median odds ratio RCT — randomised controlled trial

MRI — magnetic resonance imaging SGA — small for gestational age

NICU — neonatal intensive care unit SHiP — spontaneous haemoperitoneum in pregnancy

OR — odds ratio 17βHSD2 — 17β-hydroxysteroid dehydrogenase type 2

PAPP-A — pregnancy-associated plasma protein-A

Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — Rafi J et al. Obstetric and perinatal outcomes in women with endometriosis. TOG 2022;24:242–250. doi:10.1111/tog.12831

Clinically reviewed by NHS obstetricians and gynaecologists

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