risk management

Obstetric Complications Are Common Among Women With Endometriosis

Deep infiltrating endometriosis and adenomyosis predispose women to a host of obstetric complications, results of a systemic literature review show. Complications include preterm birth, delivery by caesarean section, and placental malposition and insertion disorders.

To summarize evidence regarding the importance of deep infiltrating endometriosis and adenomyosis as risk factors for obstetric complications, researchers at the Berlin University of Medicine in Berlin, Germany, conducted a systemic literature review.

The review was based on a search of PubMed, Scopus, and Web of Science for meta-analyses, reviews, and controlled observational studies published between January 1, 1940, and March 10, 2020. After screening the results according to inclusion criteria based on search terms and patient population characteristics, 20 studies were included in the analysis.

The analysis revealed that preterm birth, delivery by caesarean section, and placental malposition and insertion disorders were associated with the diagnoses of deep infiltrating endometriosis and adenomyosis. In addition, studies found that women with deep infiltrating endometriosis and adenomyosis seem to be at increased risk of pre-eclampsia, gestational hypertension, premature rupture of membranes, placental abruption, and giving birth to children with low birth weights.

Limitations to these findings include lack of adjustment for important confounders such as multiple pregnancies, parity, mode of conception, and maternal age. In addition, many studies attempted to evaluate endometriosis, deep infiltrating endometriosis, and adenomyosis as separate risk factors. As a result, according to the researchers, prospective studies with more cases and appropriate adjustment for confounding variables are needed to prove causality.

Regarding patient management, the researchers commented that “Ideally, there should be the possibility of consulting an [endometriosis] specialist with surgical experience.”

Furthermore, after noting that endometriosis and adenomyosis appear to share archimetrosis as a common pathophysiology, they recommended that “women with archimetrosis [should] give birth in an experienced obstetric setting. In antenatal care, placental insertion disorders need to be ruled out by targeted ultrasound examinations.”


—Ellen Kurek



Gruber TM, Ortlieb L, Henrich W, Mechsner S. Deep infiltrating endometriosis and adenomyosis: implications on pregnancy and outcome. J Clin Med. 2021;11(157):1-12. doi:10.3390/jcm11010157