A Relationship Between Endometriosis and Obstetric Complications

The aim of this review is to summarize the current literature regarding a link between endometriosis and adverse pregnancy outcomes. We also present an overview of common pathogenic mechanisms between endometriosis and obstetric complications. A computerized literature search was performed to identify relevant studies. The search covered the period between January 2008 and October 2018. Emerging evidence has revealed that endometriosis increased the risk of preterm birth, miscarriage, preterm premature rupture of membranes, placenta previa, preeclampsia, pregnancy-induced hypertension (PIH), gestational diabetes, gestational cholestasis, small for gestational age (SGA) babies, antepartum hemorrhage, postpartum hemorrhage, placental abruption, retained placenta, malpresentation, labor dystocia, cesarean delivery, stillbirth, neonatal death, and congenital malformations of the uterus, but the data are based on limited information. However, some studies have found that endometriosis did not affect pregnancy outcomes. Previous studies are heterogenous and the existing data are controversial. Limited evidence from a few studies also indicated that surgical excision of endometriosis may not reduce the risk of adverse pregnancy outcomes. Endometriosis and obstetric complications may share common pathophysiologic mechanisms, in which abnormal activation of inflammation, structural and functional alterations in the junctional zone, and perturbed uterine peristalsis may play important roles. In this review, we outlined evidence that women with endometriosis have a high risk of obstetric complications. We describe the common crucial features between endometriosis and obstetric complications.