CC BY 4.0 · Rev Bras Ginecol Obstet 2020; 42(04): 200-210
DOI: 10.1055/s-0040-1708885
Original Article
Endometriosis
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Is there an Increased Risk for Unfavorable Obstetric Outcomes in Women with Endometriosis? An Evaluation of Evidences

Existe um risco maior para desfechos obstétricos desfavoráveis em mulheres com endometriose? Uma avaliação das evidências
1   Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
,
1   Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
,
1   Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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1   Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
› Author Affiliations
Further Information

Publication History

11 September 2019

21 January 2020

Publication Date:
24 April 2020 (online)

Abstract

Objective The present study is a systematic review of the literature to assess whether the presence of endometriosis determines or contributes to adverse obstetric outcomes.

Data Sources The present work was carried out at the Hospital Israelita Albert Einstein, São Paulo, state of São Paulo, Brazil, in accordance to the PRISMA methodology for systematic reviews. A review of the literature was performed using PubMed, Web of Science and Scopus databases. The keywords used were: pregnancy outcome, pregnancy complications, obstetrical complications, obstetrics, obstetric outcomes and endometriosis. The survey was further completed by a manually executed review of cross-referenced articles, which was last performed on November 30, 2018.

Selection of studies The survey disclosed a total of 2,468 articles, published from May 1946 to October 2017. A total of 18 studies were selected to be further classified according to their quality and relevance.

Data Collection The Newcastle–Ottawa Quality Assessment Scale was used for classification. Five studies of greater impact and superior evidence quality and 13 studies of moderate evidence quality were selected. We analyzed the studies for the characteristics of their patients plus how endometriosis was diagnosed and their respective obstetric outcomes taking into account their statistical relevance.

Data Synthesis Analyses of the higher impact and better quality studies have shown high incidence of preterm birth and placenta previa in patients with endometriosis.

Conclusion Placenta previa and preterm birth are the most statistically significant outcomes related to endometriosis, as indicated by our systematic review. The present information is useful to alert obstetricians and patients about possible unfavorable obstetric outcomes.

Resumo

Objetivo Realizar uma revisão sistemática e crítica da literatura de modo a avaliar se a presença de endometriose determina desfechos obstétricos adversos na gestação.

Fonte dos dados O presente estudo foi realizado no Hospital Israelita Albert Einstein, São Paulo, SP, Brasil, de acordo com a metodologia PRISMA para revisões sistemáticas. As bases de dados usadas para a revisão de literatura foram Pubmed, Web of Science e Scopus. As palavras-chave usadas foram: pregnancy outcome, pregnancy complications, obstetrical complications, obstetrics, obstetric outcomes e endometriosis. Uma revisão manual de artigos com referências cruzadas completou a pesquisa, que foi realizada pela última vez em 30 de novembro de 2018.

Seleção dos estudos A pesquisa contou com o total de 2.468 artigos, publicados de maio de 1946 a outubro de 2017. Foram selecionados 18 estudos com base em sua relevância.

Coleta de dados A metodologia Newcastle–Ottawa Quality Assessment Scale foi usada para selecionar 5 estudos cuja evidência era de melhor qualidade e 13 estudos de moderada qualidade de evidência. As características das populações dos estudos foram analisadas, assim como a doença endometriose foi diagnosticada e os respectivos desfechos obstétricos nas pacientes observando-se a relevância estatística dos estudos.

Síntese dos dados A análise dos estudos de maior impacto e de melhor qualidade de evidência mostram que placenta prévia e ocorrência de nascimentos pré-termo são os desfechos obstétricos desfavoráveis de maior incidência em pacientes com endometriose.

Conclusão Placenta prévia e nascimentos pré-termo são os desfechos obstétricos com maior significância estatística relacionados à endometriose. Esta informação é útil para alertar obstetras e pacientes com endometriose para possíveis desfechos obstétricos desfavoráveis.

Contributors

All of the authors contributed to the conception and design of the present study, to the data collection, or to the analysis and interpretation of data, as well as to the writing of the article or to the critical review of the intellectual content and to the final approval of the version to be published.


Supplementary Material

 
  • References

  • 1 Vercellini P, Viganò P, Somigliana E, Fedele L. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol 2014; 10 (05) 261-275 . Doi: 10.1038/nrendo.2013.255
  • 2 Nakamura DS, Edwards AK, Ahn SH, Thomas R, Tayade C. Compatibility of a novel thrombospondin-1 analog with fertility and pregnancy in a xenograft mouse model of endometriosis. PLoS One 2015; 10 (03) e0121545 . Doi: 10.1371/journal.pone.0121545
  • 3 Howard FM. Endometriosis and mechanisms of pelvic pain. J Minim Invasive Gynecol 2009; 16 (05) 540-550 . Doi: 10.1016/j.jmig.2009.06.017
  • 4 Eisenberg VH, Weil C, Chodick G, Shalev V. Epidemiology of endometriosis: a large population-based database study from a healthcare provider with 2 million members. BJOG 2018; 125 (01) 55-62 . Doi: 10.1111/1471-0528.14711
  • 5 Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D'Hooghe T, De Bie B. , et al; European Society of Human Reproduction and Embryology. ESHRE guideline: management of women with endometriosis. Hum Reprod 2014; 29 (03) 400-412 . Doi: 10.1093/humrep/det457
  • 6 Jaques AM, Amor DJ, Baker HW, Healy DL, Ukoumunne OC, Breheny S. , et al. Adverse obstetric and perinatal outcomes in subfertile women conceiving without assisted reproductive technologies. Fertil Steril 2010; 94 (07) 2674-2679 . Doi: 10.1016/j.fertnstert.2010.02.043
  • 7 Healy DL, Breheny S, Halliday J, Jaques A, Rushford D, Garret C. , et al. Prevalence and risk factors for obstetric haemorrhage in 6730 singleton births after assisted reproductive technology in Victoria Australia. Hum Reprod 2010; 25 (01) 265-274 . Doi: 10.1093/humrep/dep376
  • 8 Brosens I, Pijnenborg R, Benagiano G. Defective myometrial spiral artery remodelling as a cause of major obstetrical syndromes in endometriosis and adenomyosis. Placenta 2013; 34 (02) 100-105 . Doi: 10.1016/j.placenta.2012.11.017
  • 9 Benagiano G, Brosens I, Habiba M. Structural and molecular features of the endomyometrium in endometriosis and adenomyosis. Hum Reprod Update 2014; 20 (03) 386-402 . Doi: 10.1093/humupd/dmt052
  • 10 Gentilini D, Perino A, Viganò P, Chiodo I, Culcinella G, Vignali M. , et al. Gene expression profiling of peripheral blood mononuclear cells in endometriosis identifies genes altered in non-gynaecologic chronic inflammatory diseases. Hum Reprod 2011; 26 (11) 3109-3117 . Doi: 10.1093/humrep/der270
  • 11 Aguilar HN, Mitchell BF. Physiological pathways and molecular mechanisms regulating uterine contractility. Hum Reprod Update 2010; 16 (06) 725-744 . Doi: 10.1093/humupd/dmq016
  • 12 Lazzarin N, Exacoustos C, Vaquero E, De Felice G, Manfellotto D, Zupi E. Uterine junctional zone at three-dimensional transvaginal ultrasonography in patients with recurrent miscarriage: a new diagnostic tool?. Eur J Obstet Gynecol Reprod Biol 2014; 174: 128-132 . Doi: 10.1016/j.ejogrb.2013.12.014
  • 13 Zullo F, Spagnolo E, Saccone G, Acunzo M, Xodo S, Ceccaroni M, Berghella V. , et al. Endometriosis and obstetrics complications: a systematic review and meta-analysis. Fertil Steril 2017; 108 (04) 667-672.e5 . Doi: 10.1016/j.fertnstert.2017.07.019
  • 14 Glavind MT, Møllgaard MV, Iversen ML, Arendt LH, Forman A. Obstetrical outcome in women with endometriosis including spontaneous hemoperitoneum and bowel perforation: a systematic review. Best Pract Res Clin Obstet Gynaecol 2018; 51: 41-52 . Doi: 10.1016/j.bpobgyn.2018.01.018
  • 15 Wells GA, Shea B, O'Connell D. , et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa: Ottawa Hospital Research Institute; 2014
  • 16 Berlac JF, Hartwell D, Skovlund CW, Langhoff-Roos J, Lidegaard Ø. Endometriosis increases the risk of obstetrical and neonatal complications. Acta Obstet Gynecol Scand 2017; 96 (06) 751-760 . Doi: 10.1111/aogs.13111
  • 17 Glavind MT, Forman A, Arendt LH, Nielsen K, Henriksen TB. Endometriosis and pregnancy complications: a Danish cohort study. Fertil Steril 2017; 107 (01) 160-166 . Doi: 10.1016/j.fertnstert.2016.09.020
  • 18 Mannini L, Sorbi F, Noci I, Ghizzoni V, Perelli F, Di Tommaso M. , et al. New adverse obstetrics outcomes associated with endometriosis: a retrospective cohort study. Arch Gynecol Obstet 2017; 295 (01) 141-151 . Doi: 10.1007/s00404-016-4222-7
  • 19 Saraswat L, Ayansina DT, Cooper KG, Bhattacharya S, Miligkos D, Horne AW, Battacharya S. Pregnancy outcomes in women with endometriosis: a national record linkage study. BJOG 2017; 124 (03) 444-452 . Doi: 10.1111/1471-0528.13920
  • 20 Stephansson O, Kieler H, Granath F, Falconer H. Endometriosis, assisted reproduction technology, and risk of adverse pregnancy outcome. Hum Reprod 2009; 24 (09) 2341-2347 . Doi: 10.1093/humrep/dep186
  • 21 Turocy J, Farland LV, Yanushpolsky E. Pregnancy outcomes in frozen embryo transfers in women with endometriosis: a retrospective cohort study. Fertil Steril 2017; 108 (03) E198 . Doi: 10.1016/j.fertnstert.2017.07.584
  • 22 Santulli P, Marcellin L, Menard S, Thubert T, Khodhnood B, Gayet V. , et al. Increased rate of spontaneous miscarriages in endometriosis-affected women. Hum Reprod 2016; 31 (05) 1014-1023 . Doi: 10.1093/humrep/dew035
  • 23 Fujii T, Wada-Hiraike O, Nagamatsu T, Harada M, Hirata T, Koga K. , et al. Assisted reproductive technology pregnancy complications are significantly associated with endometriosis severity before conception: a retrospective cohort study. Reprod Biol Endocrinol 2016; 14 (01) 73 . Doi: 10.1186/s12958-016-0209-2
  • 24 Lin H, Leng JH, Liu JT, Lang JH. Obstetric outcomes in Chinese women with endometriosis: a retrospective cohort study. Chin Med J (Engl) 2015; 128 (04) 455-458 . Doi: 10.4103/0366-6999.151077
  • 25 Conti N, Cevenini G, Vannuccini S. , et al. Women with endometriosis at first pregnancy have an increased risk of adverse obstetric outcome. J Matern Fetal Neonatal Med 2015; 28 (15) 1795-1798 . Doi: 10.3109/14767058.2014.968843
  • 26 Aris A. A 12-year cohort study on adverse pregnancy outcomes in Eastern Townships of Canada: impact of endometriosis. Gynecol Endocrinol 2014; 30 (01) 34-37 . Doi: 10.3109/09513590.2013.848425
  • 27 Mekaru K, Masamoto H, Sugiyama H, Asato K, Heshiki C, Kinjyo T, Aoki Y. Endometriosis and pregnancy outcome: are pregnancies complicated by endometriosis a high-risk group?. Eur J Obstet Gynecol Reprod Biol 2014; 172: 36-39 . Doi: 10.1016/j.ejogrb.2013.10.024
  • 28 Vercellini P, Parazzini F, Pietropaolo G, Cipriani S, Frattaruolo MP, Fedele L. Pregnancy outcome in women with peritoneal, ovarian and rectovaginal endometriosis: a retrospective cohort study. BJOG 2012; 119 (12) 1538-1543 . Doi: 10.1111/j.1471-0528.2012.03466.x
  • 29 Hadfield RM, Lain SJ, Raynes-Greenow CH, Morris JM, Roberts CL. Is there an association between endometriosis and the risk of pre-eclampsia? A population based study. Hum Reprod 2009; 24 (09) 2348-2352 . Doi: 10.1093/humrep/dep123
  • 30 Brosens IA, De Sutter P, Hamerlynck T, Imeraj L, Yao Z, Cloke B. , et al. Endometriosis is associated with a decreased risk of pre-eclampsia. Hum Reprod 2007; 22 (06) 1725-1729 . Doi: 10.1093/humrep/dem072
  • 31 Hjordt Hansen MV, Dalsgaard T, Hartwell D, Skovlund CW, Lidegaard O. Reproductive prognosis in endometriosis. A national cohort study. Acta Obstet Gynecol Scand 2014; 93 (05) 483-489 . Doi: 10.1111/aogs.12373
  • 32 Matorras R, Rodríguez F, Gutierrez de Terán G, Pijoan JI, Ramón O, Rodríguez-Escudero FJ. Endometriosis and spontaneous abortion rate: a cohort study in infertile women. Eur J Obstet Gynecol Reprod Biol 1998; 77 (01) 101-105 . Doi: 10.1016/s0301-2115(97)00181-4
  • 33 Harada T, Taniguchi F, Onishi K, Kurozawa Y, Hayashi K, Harada T. ; Japan Environment & Children's Study Group. Obstetrical complications in women with endometriosis: a cohort study in Japan. PLoS One 2016; 11 (12) e0168476 . Doi: 10.1371/journal.pone.0168476
  • 34 Jacques M, Freour T, Barriere P, Ploteau S. Adverse pregnancy and neo-natal outcomes after assisted reproductive treatment in patients with pelvic endometriosis: a case-control study. Reprod Biomed Online 2016; 32 (06) 626-634 . Doi: 10.1016/j.rbmo.2016.03.005
  • 35 Leone Roberti Maggiore U, Ferrero S, Mangili G, Bergamini A, Inversetti A, Giorgione V. , et al. A systematic review on endometriosis during pregnancy: diagnosis, misdiagnosis, complications and outcomes. Hum Reprod Update 2016; 22 (01) 70-103 . Doi: 10.1093/humupd/dmv045
  • 36 Petraglia F, Arcuri F, de Ziegler D, Chapron C. Inflammation: a link between endometriosis and preterm birth. Fertil Steril 2012; 98 (01) 36-40 . Doi: 10.1016/j.fertnstert.2012.04.051
  • 37 Oyelese Y, Smulian JC. Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol 2006; 107 (04) 927-941 . Doi: 10.1097/01.AOG.0000207559.15715.98
  • 38 Ioannidis JP. Why most published research findings are false. PLoS Med 2005; 2 (08) e124 . Doi: 10.1371/journal.pmed.0020124
  • 39 Prinz F, Schlange T, Asadullah K. Believe it or not: how much can we rely on published data on potential drug targets?. Nat Rev Drug Discov 2011; 10 (09) 712 . Doi: 10.1038/nrd3439-c1
  • 40 Kao LC, Germeyer A, Tulac S, Lobo S, Yang JP, Taylor RN. , et al. Expression profiling of endometrium from women with endometriosis reveals candidate genes for disease-based implantation failure and infertility. Endocrinology 2003; 144 (07) 2870-2881 . Doi: 10.1210/en.2003-0043