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Obstetric complications after laparoscopic excision of posterior deep infiltrating endometriosis: a case–control study

      Objective

      To study obstetric outcomes and complications in women with previously excised posterior deep infiltrating endometriosis (DIE) in comparison with women without endometriosis.

      Design

      Matched case–control study.

      Setting

      Tertiary-level academic center.

      Patient(s)

      All surgeries for endometriosis performed in the Department of Gynecology and Gynecological Oncology, University of Bern between March 2004 and July 2015, were assessed. Inclusion criteria included complete laparoscopic excision of posterior DIE. Exclusion criteria included concomitant hysterectomies, refusal to participate, and patients lost to follow-up. Each subsequent pregnancy was matched to three controls by maternal age, parity, history of cesarean, and mode of conception.

      Intervention(s)

      None.

      Main Outcome Measure(s)

      Obstetric complications.

      Result(s)

      Among 841 patients with surgically diagnosed endometriosis, 125 satisfied the inclusion and exclusion criteria. Of these, 73 pregnancies resulted, although a further 11 patients were excluded owing to early miscarriages or extrauterine pregnancies. The final study cohort included 62 singleton pregnancies matched to 186 controls. The analysis identified an increased risk of placenta previa, gestational hypertension, and intrauterine growth restriction for the case group. The possibility of successful vaginal delivery was similar between groups. Moreover, no significant increase in risk of maternal and neonatal delivery complications, except for a slightly higher postpartum blood loss in the case group, was observed.

      Conclusion(s)

      Despite previous surgical excision, women with history of DIE present a higher risk of placenta previa, gestational hypertonia, and intrauterine growth restriction during pregnancy. Previous surgery for DIE does not seem to predispose to failed vaginal delivery.
      Complicaciones obstétricas en mujeres con endometriosis profunda infiltrante en compartimento posterior sometidas a excisión laparoscópica: estudio de casos y controles

      Objetivo

      Evaluar el resultado y las complicaciones obstétricas en mujeres con cirugía previa con excisión de endometriosis profunda infiltrante (DIE) del compartimento posterior comparándose con mujeres sin endometriosis.

      Diseño

      Estudio comparativo casos-controles.

      Lugar

      Centro académico de tercer nivel.

      Pacientes

      Revisión de todas las cirugías de pacientes con endometriosis realizadas en el Departamento de Ginecología y Ginecología Oncológica, Universidad de Berna entre marzo de 2004 y julio de 2015.Los criterios de inclusión incluían laparoscopias con excisión completa de DIE posterior. Fueron criterios de exclusión las histerectomías concomitantes, la negativa a participar en el estudio y las pacientes pérdidas para seguimiento/ el abandono de las pacientes del estudio. Cada embarazo subsiguiente fue comparado con tres controles según edad materna, paridad, historia de cesáreas previas y modo de concepción.

      Intervenciones

      Ninguna.

      Resultados principales

      Complicaciones obstétricas.

      Resultados

      Entre las 841 pacientes diagnosticadas con endometriosis quirúrgicamente, 125 cumplían los criterios de inclusión y exclusión. De ellas, 73 lograron el embarazo, aunque posteriormente 11 pacientes fueron excluídas por sufrir abortos precoces o gestaciones extrauterinas. La cohorte final del estudio incluyó a 62 embarazos únicos comparados con 186 controles. El análisis identificó un aumento del riesgo de placenta previa, hipertensión gestacional y crecimiento intrauterino retardado en estos casos de estudio. La probabilidad de parto vaginal fue similar entre los dos grupos. Además, no se observó aumento significativo de riesgo para complicaciones maternas ni neonatales en el parto, excepto un ligero incremento del sangrado postparto en el grupo de casos de estudio.

      Conclusiónes

      A pesar de la excisión quirúrgica previa, las mujeres con antecedentes de DIE presentan un mayor riesgo de placenta previa, hipertonía gestacional y crecimiento intrauterino retardado durante el embarazo. La cirugía previa por DIE no parece predisponer al fracaso del parto vaginal.

      Key Words

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