The Effect Of Endometriosis On Pregnancy Outcome:Meta-analysis

Objective:To investigate whether endometriosis increases the risk of hypertensive disease and other adverse pregnancy outcomes during pregnancy.Methods:Through the search of China National Knowledge Network(CNKI),China Biomedical Literature Database(CBM),Wanfang Database,VIP Series Database,The Cochrane Library,Pub Med,Embase,Web of Science,The literature was collected from January 1st,1970 to December 31 st,2020 to report the perinatal adverse pregnancy outcomes of women diagnosed with Endometriosis in cohort studies and pathologic control studies.The subject word of Mesh was"Endometriosis"."Pregnancy Outcome;"A case control study";"Cohort analysis";Relative risk,and the free words "Endometrioses" or "Endometrioma" or"Pregnancy Outcomes" or "Outcome,Pregnancy" or "Outcomes,Pregnancy" were used to retrieve the literature.Chinese search keywords were "endometriosis","pregnancy outcome","case-control trial" and "cohort study".At the same time,the literature was searched by the combination of free words(endometriosis,chocolate cyst,spontaneous abortion,premature birth,placenta previa,ectopic pregnancy,full-term live birth,postpartum hemorrhage,stillbirth,gestational hypertension,gestational diabetes,gestational intrahepatic cholestasis,cesarean section rate,case control).The main outcome indicators were hypertensive disease during pregnancy.Secondary outcomes included preterm birth,stillbirth,placental abruption,placenta previa,gestational diabetes,and postpartum hemorrhage.The inclusion criteria were established according to the PICOS principle and evaluated by 2researchers according to the inclusion criteria.If there were differences,we solved the problems through discussion and negotiation with the third reviewers.The original data of each study were extracted and the study quality was evaluated using the NOS scale.First,the heterogeneity of each study was examined.According to the test results,effect models(including fixed effect model and random effect model)were selected for combination analysis.When P >0.1 and I2<50%,heterogeneity was defined as negligible and fixed effect model was selected.When 50%≤I2 < 85%,if the heterogeneity is not easy to be ignored,the random effects model was selected to be combined,and the sensitivity analysis was carried out and then the fixed model was used for further analysis.Results:A total of 3069 articles were retrieved.Only 10 studies with total of 2107633cases(51082 cases were with Endometriosis in pregnancy women and 2056551 were without Endometriosis in pregnancy women)were included in the Meta-analysis.The results of meta-analysis showed that,the incidence of the incidence of hypertensive disorders of pregnancy(RR=1.19,95%CI:1.14-1.25,P<0.0001);stillbirth(RR=1.66,95%CI:1.53-1.80,P<0.0001);placental abruption(RR=1.29,95%CI:1.15-1.45,P<0.0001);placenta previa(RR=3.28,95%CI:3.12-3.44,P<0.0001).Postpartum hemorrhage(RR=1.11,95%CI:1.08-1.15,P<0.0001);gestational diabetes is not statistically significant;premature delivery(RR=1.27,95%CI:1.16-1.39,P<0.0001).Conclusion:Endometriosis increasing gestational hypertension disease and stillbirth,placenta previa,placental abruption,postpartum hemorrhage,premature birth,such as the risk of obstetric complications,and so on endometriosis pregnant women should strengthen the prenatal care,is necessary for blood to prevent postpartum hemorrhage,and at the same time needed to step on perinatal monitoring blood pressure,blood sugar,etc.,thus to conduct a comprehensive analysis of the actual condition,timely symptomatic treatment,early intervention,thus ensuring the overall security of the process of pregnancy,decrease the rate of neonatal stillbirth,improve the perinatal child survival rate and survival quality.Reduce perinatal complications as much as possible.