title: New adverse obstetrics outcomes associated with endometriosis: a retrospective cohort study.
abstract: OBJECTIVE
  The main aim of this study was to evaluate the incidence of endometriosis and intrahepatic cholestasis (ICP) and induction of labor in pregnant women with endometriosis compared with women without endometriosis. The secondary aim was to confirm increased incidence of already known endometriosis-related pregnancy complications in these patients.
  
  
  METHODS
  This is a retrospective cohort study performed at a tertiary hospital between January 2009 and December 2014 to compare obstetrics outcome between women with endometriosis and women without endometriosis. Pregnant patients with endometriosis were included in the study group. Patients were divided in the following subgroups: patients with deep infiltrating endometriosis (DIE subgroup) and patients without deep infiltrating endometriosis (non-DIE subgroup); patients with singleton pregnancy and spontaneous conception (subgroup A) and patients with multiple pregnancy and/or patients who underwent assisted reproductive technology (subgroup B). To form a control group, for each patient with endometriosis, two patients without endometriosis were selected as the control group by means of matched sample.
  
  
  RESULTS
  The study population included 262 pregnant women with endometriosis and 524 controls. Patients of the study population had significantly increased risks of placenta praevia (p < 0.05), ICP (p < 0.01), induction of labor (p < 0.01) and preterm birth (p < 0.01). DIE patients had a significantly higher percentage only of preterm birth (p < 0.01), while in non-DIE group all complications had a higher incidence except for placenta praevia, which did not differ with control. Subgroup A had a statistically higher incidence of placenta praevia (p < 0.01), ICP (p < 0.01), induction of labor (p < 0.01) and preterm birth (p < 0.01) compared to its control subgroup. There was no difference in distribution of pregnancy complications between subgroup B and control subgroup.
  
  
  CONCLUSIONS
  Our results showed for the first time that women with endometriosis are at higher risk of developing ICP and experiencing an induced labor. Further studies are warranted to clarify whether the history of endometriosis might be taken into account in the antenatal care of these patients.
authors: Department of Biomedical, Clinical and Experimental Sciences, University of Florence, Viale Morgagni 50, 50134, Florence, Italy. lucamannini@libero.it.
authors: Luca
authors: L
authors: Mannini
authors: Department of Biomedical, Clinical and Experimental Sciences, University of Florence, Viale Morgagni 50, 50134, Florence, Italy.
authors: Flavia
authors: F
authors: Sorbi
authors: Department of Biomedical, Clinical and Experimental Sciences, University of Florence, Viale Morgagni 50, 50134, Florence, Italy.
authors: Ivo
authors: I
authors: Noci
authors: Department of Biomedical, Clinical and Experimental Sciences, University of Florence, Viale Morgagni 50, 50134, Florence, Italy.
authors: Viola
authors: V
authors: Ghizzoni
authors: Department of Biomedical, Clinical and Experimental Sciences, University of Florence, Viale Morgagni 50, 50134, Florence, Italy.
authors: Federica
authors: F
authors: Perelli
authors: Department of Health Science, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
authors: Mariarosaria
authors: M
authors: Di Tommaso
authors: Department of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy.
authors: Alberto
authors: A
authors: Mattei
authors: Department of Biomedical, Clinical and Experimental Sciences, University of Florence, Viale Morgagni 50, 50134, Florence, Italy.
authors: Massimiliano
authors: M
authors: Fambrini
mesh_terms: D000328:Adult; D002780:Cholestasis, Intrahepatic / Q000150:complications*; D015331:Cohort Studies; D004715:Endometriosis / Q000150:complications*; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology*; D012189:Retrospective Studies
keywords: Endometriosis; Induction of labor; Intrahepatic cholestasis; Pregnancy outcome