We have seen that endometriosis is associated with infertility. What is more, we know that the symptoms of the disease, typically, improve during pregnancy. Is the disease, however, associated with direct effects on the pregnancy itself?

Unfortunately, in the literature, there is a paucity of high-quality data answering this topic clearly. Τhere have been rare case reports of serious complications during pregnancy, e.g. bowel perforation¹, internal haemorrhage from vascular damage², uterine perforation³ and urological complications⁴. Thankfully, they are all rare.

As regards the effect of endometriosis on pregnancy, there is no increase in the risk of developing hypertension in pregnancy/ preeclampsia, gestational diabetes mellitus or obstetric haemorrhage⁴. However, it may be associated with slightly higher risk of miscarriage, preterm labour and small-for-gestational age (SGA) babies⁴. It also appears to be associated with a higher risk of low-lying placenta⁵.

As regards the choice between normal birth or elective caesarean section, endometriosis is associated with a higher risk of caesarean section⁴. Past history of endometriosis surgery does not exclude the chance of normal birth, with certain exceptions (e.g., removal of large part of the vagina, bowel resection with risk of obstetric anal sphincter injury in case of vaginal birth etc.).

In conclusion, the effect of the disease itself in the pregnancy outcome is not significant enough to warrant a change in routine antenatal care. Pregnant women with history of endometriosis do not require additional tests or interventions. The choice between elective caesarean section and normal birth requires an in-depth discussion with the obstetrician during the antenatal period.

References:

1. Pisanu A, Deplano D, Angioni S, Ambu R, Uccheddu A. Rectal perforation from endometriosis in pregnancy: case report and literature review. World J Gastroenterol. 2010 Feb 7;16(5):648-51.

2. Brosens IA, Fusi L, Brosens JJ. Endometriosis is a risk factor for spontaneous hemoperitoneum during pregnancy. Fertil Steril. 2009 Oct;92(4):1243-1245.

3. Roberta Granese (2010) Acute abdomen in pregnancy with endometriosis, Acta Obstetricia et Gynecologica Scandinavica, 89:6, 844-845.

4. Umberto Leone Roberti Maggiore, Simone Ferrero, Giorgia Mangili, Alice Bergamini, Annalisa Inversetti, Veronica Giorgione, Paola Viganò, Massimo Candiani, A systematic review on endometriosis during pregnancy: diagnosis, misdiagnosis, complications and outcomes, Human Reproduction Update, Volume 22, Issue 1, January/February 2016, Pages 70–103.

5. Kunz G, Beil D, Huppert P, Leyendecker G. Structural abnormalities of the uterine wall in women with endometriosis and infertility visualised by vaginal sonography and magnetic resonance imaging. Hum Reprod 2000;15:76 –82.