Expert consensus on the obstetric management of pregnant patients with endometriosis: A modified Delphi study

Endometriosis affects approximately 10% of reproductive-age women and has been associated with adverse obstetric outcomes. However, evidence guiding antenatal management remains limited and inconsistent.

To develop evidence-based, consensus-driven recommendations for the management of spontaneous pregnancies in women with endometriosis.

A modified Delphi process was conducted in France, involving two rounds of structured surveys and a final consensus meeting with expert obstetrician-gynecologists. A systematic literature review informed the development of clinical statements. Experts rated recommendations using a 9-point Likert scale. Consensus-defined recommendations were synthesized and graded using a GRADE-informed approach.

Twenty-three experts from 21 French centers participated. Across clinical domains, including hypertensive disorders, fetal growth, preterm birth, miscarriage, placenta praevia, venous thromboembolism, gestational diabetes, postpartum hemorrhage, and contraception, experts consistently supported standard antenatal care without systematic intensification. No evidence supported routine additional surveillance or preventive interventions specific to endometriosis. Risk-adapted thromboprophylaxis, active management of the third stage of labor, and early postpartum hormonal contraception were recommended.

In women with endometriosis, routine antenatal care remains appropriate in the absence of additional risk factors. Despite reported associations with adverse outcomes, there is no evidence supporting systematic modification of standard management. A conservative, individualized approach is recommended, highlighting the need for high-quality prospective studies to refine care strategies.