title: Effects of Previous Laparoscopic Surgical Diagnosis of Endometriosis on Pregnancy Outcomes.
abstract: BACKGROUND
  The association between the previous history of endometriosis and obstetric outcomes is still ambiguous. This study aimed to evaluate the effects of previous history of operatively diagnosed endometriosis on pregnancy outcomes.
  
  
  METHODS
  A total of 98 primiparous women who had been diagnosed with endometriosis by previous laparoscopic surgery were included in this retrospective cohort study. Pregnancy outcomes were compared between these women (study group) who had a live birth and 300 women without endometriosis (control group) who had a live birth. In the study group, the pregnancy outcomes of 74 women who conceived naturally (no assisted reproductive technology [ART] subgroup) were simultaneously compared with 24 women who conceived by ART (ART subgroup).
  
  
  RESULTS
  Miscarriage was observed in 23 of 98 women with endometriosis (23.5%). There were 75 women who had a live birth after laparoscopic diagnosis of endometriosis in the study group eventually. On multivariate analysis, the postpartum hemorrhage rate increased significantly in the study group when compared with the control group (adjusted odds ratio: 2.265, 95% confidence interval: 1.062, 4.872; P = 0.034). There was an upward tendency of developing other pregnancy-related complications, such as preterm birth, placental abruption, placenta previa, cesarean section, fetal distress/anemia, and others in the study group than in the control group. However, the differences showed no statistical significance. Within the study group, the occurrence rate of postpartum hemorrhage and preterm birth was both higher in the ART subgroup than in the no ART subgroup. The differences both had statistical significance (44.4% vs. 17.5%, P = 0.024 and 27.8% vs. 1.8%, P = 0.010, respectively). At the same time, median (interquartile range) for gestational age at delivery in the ART subgroup was significantly shorter than that in the no ART subgroup (38 weeks [36-39 weeks] vs. 39 weeks [38-40 weeks]; P = 0.005).
  
  
  CONCLUSIONS
  Endometriosis may affect obstetric outcomes. Women with endometriosis have a higher risk of postpartum hemorrhage. Women with endometriosis who conceived by ART may have a higher risk of postpartum hemorrhage and preterm birth than those conceived naturally.
authors.affiliation: Gynecological Oncology Center, Peking University People's Hospital, Beijing 100044, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China.
authors.forename: Hong-Lan
authors.initials: HL
authors.lastname: Zhu
authors.affiliation: Gynecological Oncology Center, Peking University People's Hospital, Beijing 100044, China.
authors.forename: Xiao-Hong
authors.initials: XH
authors.lastname: Chang
authors.affiliation: Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Reproductive Medicine Center, Peking University People's Hospital, Beijing 100044, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Guan
authors.affiliation: Gynecological Oncology Center, Peking University People's Hospital, Beijing 100044, China.
authors.forename: Heng
authors.initials: H
authors.lastname: Cui
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D004715:Endometriosis / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D050498:Live Birth / Q000453:epidemiology; D010923:Placenta Previa / Q000453:epidemiology / Q000209:etiology; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors