Obstetric and Neonatal Outcomes in Deep Infiltrating Versus Superficial Endometriosis: A Retrospective Cohort Study

To compare obstetric and neonatal outcomes between women with surgically confirmed deep infiltrating endometriosis (DIE) and superficial endometriosis, focusing on lesion-specific risk profiles. This retrospective cohort study included women with surgically confirmed endometriosis who achieved singleton pregnancies at a tertiary referral center between 2015 and 2024. Patients were classified as having deep infiltrating or superficial endometriosis. Obstetric and neonatal outcomes were obtained from medical records. Primary outcomes were placenta previa and preterm birth before 37 gestational weeks. Secondary outcomes included placenta-related complications, maternal perinatal outcomes, and neonatal morbidity. Multivariable logistic regression analyses were performed adjusting for maternal age, pre-pregnancy body mass index, parity, assisted reproductive technology use, adenomyosis, and previous uterine surgery. A total of 268 pregnancies were analyzed (102 DIE, 166 superficial endometriosis). Placenta previa was significantly more frequent in the DIE group and remained independently associated after adjustment (adjusted odds ratio 2.41, 95% confidence interval 1.02-5.68). Preterm birth was more common among women with DIE, but this association did not remain significant. A placenta-related composite outcome, including placenta previa and placental abruption, was independently associated with DIE. Neonatal intensive care unit admission was also more frequent in the DIE group and remained independently associated (adjusted odds ratio 1.89, 95% confidence interval 1.01-3.54). Deep infiltrating endometriosis is associated with higher risks of placenta-related complications and adverse neonatal outcomes compared with superficial endometriosis. Lesion-based phenotyping may support clinically relevant perinatal risk stratification in pregnancies complicated by endometriosis.