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Published on: January 22, 2022
Association Between Pre-Conception Surgery for Deep Endometriosis and Adverse Obstetric Outcomes: A Retrospective
Yannick Hurni1, Nuria Barbany-Freixa2, Laura Manosalvas-Escobar2
1Department of Obstetrics, Gynecology and Reproduction, Dexeus Mujer. Dexeus University Hospital, Barcelona, Spain (all authors); Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine and Public Health, Faculty of Medicine, Universidad Autonoma Barcelona, Barcelona, Spain (Drs. Y. Hurni, S. Cabrera).
Pre-conception surgery for deep endometriosis (DE) was linked to more maternal complications during pregnancy and delivery. Fetal and neonatal outcomes were similar between surgical and non-surgical groups.
Area of Science:
- Reproductive Medicine
- Surgical Gynecology
- Maternal-Fetal Medicine
Background:
- Deep endometriosis (DE) can impact fertility and pregnancy.
- The role of pre-conception surgery in optimizing obstetric outcomes for DE patients is not well-established.
Purpose of the Study:
- To investigate the association between pre-conception surgery for deep endometriosis and obstetric outcomes in nulliparous women.
Main Methods:
- Retrospective cohort study including 298 nulliparous women with singleton pregnancies and diagnosed DE.
- Comparison of obstetric outcomes between women who underwent pre-conception DE surgery (n=102) and those managed conservatively (n=196).
- Multivariable logistic regression adjusted for confounding factors; primary outcome was a composite adverse obstetric event.
Main Results:
- The composite adverse obstetric outcome occurred in 37.3% of the surgery group versus 18.9% in the no-surgery group (p<0.001).
- Pre-conception surgery was associated with increased odds of the composite outcome (aOR 2.3, 95% CI 1.2-4.3).
- Higher rates of placenta previa, hypertensive disorders, postpartum hemorrhage, and cesarean delivery were observed in the surgery group; fetal/neonatal outcomes were comparable.
Conclusions:
- Pre-conception surgical treatment for DE is associated with increased maternal obstetric morbidity.
- The observed association warrants cautious interpretation due to the observational design and potential baseline differences in disease severity.
- Further research is needed to clarify the causal relationship and optimal management strategies for DE in pregnancy.
