Beyond infertility: obstetrical and postpartum complications associated with endometriosis and adenomyosis

Fertil Steril. 2015 Oct;104(4):802-812. doi: 10.1016/j.fertnstert.2015.08.030. Epub 2015 Sep 5.

Abstract

The risk of pregnancy and neonatal complications in women with endometriosis and adenomyosis is debatable. A literature review looking at rates, presentation, and management of spontaneous hemoperitoneum, enlargement, abscess, and rupture of an endometrioma, uterine rupture, and bowel perforation in pregnant women with endometriosis was conducted. Moreover, studies addressing differences in early pregnancy (miscarriage), late pregnancy (gestational diabetes mellitus, preeclampsia, prematurity, placenta previa, placental abruption, cesarean section, hemorrhages) and neonatal outcomes (weight at birth) between endometriosis and adenomyosis patients versus control subjects were reviewed. The overall prevalence of endometriosis-related spontaneous hemoperitoneum in pregnancy is estimated to be ∼0.4%. Only four cases of endometrioma rupture in pregnancy have been reported. Although during pregnancy there is no way to anticipate the onset of complications from preexisting endometriosis, it is important, when a specific abdominal pain occurs, to suspect rare but potentially life-threating events. Population-based studies suggest a possible association of endometriosis with preterm birth and placenta previa. Limits of the published studies are noted and discussed.

Keywords: Endometriosis; adenomyosis; complication; placenta previa; pregnancy; preterm birth.

Publication types

  • Review

MeSH terms

  • Adenomyosis / complications*
  • Adenomyosis / epidemiology
  • Adenomyosis / therapy
  • Endometriosis / complications*
  • Endometriosis / epidemiology
  • Endometriosis / therapy
  • Female
  • Hemoperitoneum / epidemiology
  • Hemoperitoneum / etiology
  • Hemoperitoneum / therapy
  • Humans
  • Infant, Newborn
  • Infertility / epidemiology
  • Infertility / etiology*
  • Infertility / therapy
  • Ovarian Diseases / complications
  • Ovarian Diseases / epidemiology
  • Ovarian Diseases / therapy
  • Peritoneal Diseases / complications
  • Peritoneal Diseases / epidemiology
  • Peritoneal Diseases / therapy
  • Postpartum Period
  • Pregnancy
  • Pregnancy Complications / epidemiology
  • Pregnancy Complications / etiology*
  • Pregnancy Complications / therapy
  • Puerperal Disorders / epidemiology
  • Puerperal Disorders / etiology*
  • Puerperal Disorders / therapy