2756 Obstetric Outcomes in a Contemporary Cohort of Women with Endometriosis at an Academic Medical Center

Abstract

Study Objective Previous literature shows that women with endometriosis have higher rates of adverse pregnancy outcomes compared to the general population, including preterm birth, fetal growth restriction, and cesarean section. We aim to identify disease-specific risk factors and surgical treatments that impact obstetric outcomes. Design Retrospective cohort study. Setting Academic medical center. Patients or Participants Women who delivered at our institution from January 2002 to December 2018 with ICD-9/10 codes of endometriosis. Interventions We obtained demographic characteristics and pregnancy information from a prospectively-maintained dataset, and linked this to gynecologic data, including symptoms, infertility treatments, lesion types (superficial, deeply-infiltrative [DIE], endometrioma, adenomyosis), and prior surgeries for endometriosis—dichotomous variables for diagnostic laparoscopy, ablation/fulguration, ovarian cystectomy, superficial excision, and excision of DIE. Patients were stratified by gynecologic characteristics, and obstetric outcomes compared across groups. Measurements and Main Results Of 148 deliveries, 54 (36%) had superficial endometriosis, 14 (9.5%) DIE, 75 (51%) endometriomas, and 13 (8.8%) adenomyosis. Compared to other lesions, adenomyosis was associated with prior miscarriage (62% vs. 22%, p=0.004). Almost three-quarters (72%) of patients had undergone previous surgery, including 68% diagnostic laparoscopy, 22% ablation, 28% cystectomy, 8.8% superficial excision, and 4.1% DIE excision. 38% had previously been diagnosed with infertility, while 28% conceived through in vitro fertilization. Women with DIE more often delivered via cesarean section (71% vs. 40%, p=0.044). Compared to patients with zero or one prior surgery, the 25 patients with multiple prior surgeries (range 2 to >5) more frequently had small for gestational age infants (32% vs. 14%, p=0.015), which was independent of gestational age. There were no significant differences in obstetric outcomes (gestational age, delivery method or newborn weight) by type of endometriosis surgery. Conclusion More extensive surgical history, as evidenced by multiple prior endometriosis surgeries, was associated with having infants who were small for gestational age.