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Spontaneous delivery despite previous surgery for severe endometriosis?
The Department of Gynecology and Obstetrics at Inselspital Bern has demonstrated that endometriosis patients not only get pregnant after minimal-invasive surgery, but, contrary to the common opinion, can also experience spontaneous deliveries.
Endometriosis affects one in every ten women of childbearing age. It can cause severe pain, mainly during menstruation, and can be a factor for infertility. The disease is characterized by the growth of endometrium, the layer of tissue that normally covers only the inside of the uterus, outside of it. In rare cases, it can grow into other abdominal organs such as the bowel or the vagina (deep infiltrating endometriosis). This situation often requires surgery to remove endometriosis.
Researchers at the Department of Gynecology and Obstetrics at Inselspital, Bern University Hospital, wanted to know if pregnancy and birth are riskier for a woman who has undergone a surgery of this kind than for a woman without endometriosis. To find out, they examined 62 women following successfully performed endometriosis surgery and compared them to 186 healthy women. Their study was published in the renowned journal «Fertility and Sterility».
Fewer risks than expected
The results: The women with endometriosis had slightly higher blood loss during birth but there was apart from that no increased complication rate for mother and child. Spontaneous births were almost as frequent as in the comparison group. Given the previous bowel or vaginal surgery to treat endometriosis, it has been assumed so far that subsequent vaginal births would lead to more complications such as severe vaginal tears or prolonged labor. The principal investigator of the study, Dr. med. Konstantinos Nirgianakis, commented: «This is the first study showing that women with previous major surgery for endometriosis do not have noticeably higher birth-related risks.»
The study also shows that women with endometriosis had a slightly higher possibility of delivering smaller children (birth weight lower than average) and of suffering from elevated blood pressure during pregnancy. Moreover, a higher frequency of placenta previa was observed, a situation where the placenta blocks the birth canal.
Dr. med. Konstantinos Nirgianakis, Consultant, Endometriosis Center, Department of Gynecology and Obstetrics, Inselspital, Bern University Hospital, Konstantinos.Nirgianakis@insel.ch.
https://doi.org/10.1016/j.fertnstert.2018.04.036
Magnetic Resonance Imaging: severe endometriosis with infiltration of the bowel wall (red arrow); v: ...
Source: Department of Gynecology and Obstetrics, Inselspital, Bern University Hospital
Picture with typical localization of deep-infiltrating endometriosis between uterus and rectum.
Source: Department of Gynecology and Obstetrics, Inselspital, Bern University Hospital
Natural birth following endometriosis surgery
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