Endometriosis increases the risk of obstetrical and neonatal complications.
BACKGROUND
The objective of this study was to assess obstetrical complications and neonatal outcomes in women with endometriosis as compared with women without endometriosis.


METHODS
National cohort including all delivering women and their newborns in Denmark 1997-2014. Data were extracted from the Danish Health Register and the Medical Birth Register. Logistic regression analysis provided odds ratios (OR) with 95% confidence intervals (CI). Sub-analyses were made for primiparous women with a singleton pregnancy and for women with endometriosis who underwent gynecological surgery before pregnancy.


RESULTS
In 19 331 deliveries, women with endometriosis had a higher risk of severe preeclampsia (OR 1.7, 95% CI 1.5-2.0), hemorrhage in pregnancy (OR 2.3, 95% CI 2.0-2.5), placental abruption (OR 2.0, 95% CI 1.7-2.3), placenta previa (OR 3.9, 95% CI 3.5-4.3), premature rupture of membranes (OR 1.7, 95% CI 1.5-1.8), and retained placenta (OR 3.1, 95% CI 1.4-6.6). The neonates had increased risks of preterm birth before 28 weeks (OR 3.1, 95% CI 2.7-3.6), being small for gestational age (OR 1.5, 95% CI 1.4-1.6), being diagnosed with congenital malformations (OR 1.3, 95% CI 1.3-1.4), and neonatal death (OR 1.8, 95% CI 1.4-2.1). Results were similar in primiparous women with a singleton pregnancy. Gynecological surgery for endometriosis before pregnancy carried a further increased risk.


CONCLUSIONS
Women with endometriosis had a significantly higher risk of several complications, such as preeclampsia and placental complications in pregnancy and at delivery. The newborns had increased risk of being delivered preterm, having congenital malformations, and having a higher neonatal death rate. Pregnant women with endometriosis require increased antenatal surveillance.
Department of Obstetrics and Gynecology, Hillerød Hospital, Hillerød, Denmark.
Janne Foss
http://orcid.org/0000-0002-1487-9920
JF
Berlac
Department of Gynecology, Rigshospitalet University Hospital, Copenhagen, Denmark.
Dorthe
D
Hartwell
Department of Gynecology, Rigshospitalet University Hospital, Copenhagen, Denmark.
Charlotte Wessel
CW
Skovlund
Department of Obstetrics, Rigshospitalet University Hospital, Copenhagen, Denmark.
Jens
http://orcid.org/0000-0003-2838-2533
J
Langhoff-Roos
Department of Gynecology, Rigshospitalet University Hospital, Copenhagen, Denmark.
Øjvind
http://orcid.org/0000-0002-9157-4004
Ø
Lidegaard
D015984:Causality; D002585:Cesarean Section / Q000706:statistics & numerical data; D004715:Endometriosis / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D010921:Placenta Accreta / Q000453:epidemiology; D010923:Placenta Previa / Q000453:epidemiology; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000209:etiology; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology*; D012307:Risk Factors
Endometriosis; delivery; neonatal complications; obstetrical complications; pregnancy complications