Correlation Analysis Of Endometriosis And Its Laparoscopic Surgery With Adverse Pregnancy Outcomes

Objective:To investigate the effect of endometriosis(EMs)and its laparoscopic surgery on adverse pregnancy outcomes.Methods:Retrospective analysis was performed on the differences in the incidences of adverse pregnancy outcomes between 156 patients diagnosed with endometriosis by laparoscopic surgery or histology and 415 patients without endometriosis in our hospital from September 2012 to April 2018.Patients were divided into endometriosis group and non-endometriosis group according to whether they were diagnosed with endometriosis.The endometriosis group was further divided into the pregnancy complicated with endometriosis group and the post-operative pregnancy group according to whether laparoscopic surgery has been performed before pregnancy,and then the two groups were divided into stage ?/? group and stage ?/? group respectively according to the r-AFS stage of endometriosis.Meanwhile,according to the r-AFS stage and pathological typing of endometriosis during surgery,the post-operative pregnancy group was divided into r-AFS stage ?/? group and r-AFS stage ?/? group,ovarian endometriosis group,peritoneal endometriosis group and ovarian combined with peritoneal endometriosis group respectively.And the differences of assisted reproductive technology(ART),cesarean section(CS),progesterone treatment in early pregnancy,adverse pregnancy outcome in late pregnancy and specific adverse pregnancy outcomes(fetal distress,abnormal amniotic fluid volume,abnormal fetal position,gestational diabetes mellitus,placenta previa,premature delivery,premature rupture of membranes,placental abruption,placenta accreta,gestational hypertension,macrosomia,fetal growth restriction(FGR),abnormal labor process and postpartum hemorrhage)among the groups were compared and analyzed as well as the possible risk factors of adverse pregnancy outcome in natural conception after laparoscopic surgery for endometriosis were analyzed.Results:Compared with patients without endometriosis,patients with endometriosis showed higher incidences of assisted reproductive technology(ART),cesarean section(CS),progesterone treatment in early pregnancy,adverse pregnancy outcome in late pregnancy,abnormal fetal position,fetal distress,and placenta previa,(x2 value was 36.367?70.602?111.212?13.510?4.981?31.664?16.609,respectively,all P<0.05),significant differences were not found in the incidence of abnormal amniotic fluid volume,gestational diabetes mellitus,premature delivery,premature rupture of membranes,placental abruption,placenta accreta,gestational hypertension,macrosomia,fetal growth restriction(FGR),abnormal labor process and postpartum hemorrhage between two groups(x2 value was 0.026?0.949?0.345?0.675?0.018?2.128?0.098?0.506?0.001?0.117?1.954,respectively,all P>0.05).And the incidence of cesarean section(CS),progesterone treatment in early pregnancy,adverse pregnancy outcome in late pregnancy,abnormal fetal position,fetal distress and placenta previa in the endometriosis group were still significantly higher than the non-endometriosis group after excluding ART patients(x2 value was 70.131?78.344?12.980?4.666?26.174?10.161,respectively,all P<0.05).Compared with patients in the post-operative pregnancy group,patients in the pregnancy complicated with endometriosis group had higher incidences of cesarean section(CS)(x2 value was 22.793,P<0.01),but the incidence of assisted reproductive technology(ART)was significantly lower(x2 value was 7.160,P<0.01).and significant differences were not found in the incidence of progesterone treatment in early pregnancy,adverse pregnancy outcome in late pregnancy and specific adverse pregnancy outcomes(fetal distress,abnormal amniotic fluid volume,abnormal fetal position,gestational diabetes mellitus,placenta previa,premature delivery,premature rupture of membranes,placental abruption,placenta accreta,gestational hypertension,macrosomia,fetal growth restriction(FGR),abnormal labor process and postpartum hemorrhage between two groups(all P>0.05).After excluding the interference of previous uterine operation history?ART and r-AFS stage on pregnancy outcome,the difference in the incidence of cesarean section between the two groups was still significant.(x2 value was 21.904?23.468?9.311?6.990,respectively,all P<0.01).After excluding the interference of previous uterine operation history on pregnancy outcome,the incidence of assisted reproductive technology(ART)in the pregnancy complicated with endometriosis group was still significantly lower than the post-operative pregnancy group(x2 value was 5.675,P<0.05).And the incidence of ART in the pregnancy complicated with endometriosis group was still significantly lower than the post-operative pregnancy group in r-AFS stage ?/?(x2 value was 7.552,P<0.01).However,there was no significant difference in ART incidence between the pregnancy complicated with endometriosis group and the post-operative pregnancy group in r-AFS stage ?/?(x2 value was 0.418,P>0.05).In the r-AFS stage subgroup of the post-operative pregnancy group,significant differences were not found in the interval between laparoscopic surgery and postoperative pregnancy and the incidence of infertility,assisted reproductive technology(ART),cesarean section(CS),progesterone treatment in early pregnancy,adverse pregnancy outcome in late pregnancy and specific adverse pregnancy outcomes(fetal distress,abnormal amniotic fluid volume,abnormal fetal position,gestational diabetes mellitus,placenta previa,premature delivery,premature rupture of membranes,placental abruption,placenta accreta,gestational hypertension,macrosomia,fetal growth restriction(FGR),abnormal labor process and postpartum hemorrhage)between r-AFS stage ?/?group and r-AFS stage ?/? group(all P>0.05).In the pathological typing subgroup of the post-operative pregnancy group,the incidence of infertility was significantly higher in peritoneal endometriosis alone group and ovarian combined with peritoneal endometriosis group than the ovarian endometriosis alone group(x2 value was 14.228?13.600,respectively,all P<0.01),while the incidence of infertility between the peritoneal endometriosis alone group and ovarian combined with peritoneal endometriosis group had no significant difference(x2 value was 1.833,P>0.05).The incidence of r-AFS stage ?/? in the ovarian combined with peritoneal endometriosis group was significantly higher than the ovarian endometriosis alone group and peritoneal endometriosis alone group,and the incidence of r-AFS stage ?/? in the ovarian endometriosis alone group was also significantly higher than the peritoneal endometriosis alone group(x2 value was 6.746?31.534?12.233,respectively,all P<0.01).The interval between laparoscopic surgery and postoperative pregnancy for ovarian combined with peritoneal endometriosis was significantly longer than that for ovarian endometriosis alone(P<0.01).But,between ovarian combined with peritoneal endometriosis group and peritoneal endometriosis alone group,ovarian endometriosis alone group and peritoneal endometriosis alone group,there is no significant difference were found(all P>0.05).And significant differences were not found in the incidence of assisted reproductive technology(ART),cesarean section(CS),progesterone treatment in early pregnancy,adverse pregnancy outcome in late pregnancy and specific adverse pregnancy outcomes(fetal distress,abnormal amniotic fluid volume,abnormal fetal position,gestational diabetes mellitus,placenta previa,premature delivery,premature rupture of membranes,placental abruption,placenta accreta,gestational hypertension,macrosomia,fetal growth restriction(FGR),abnormal labor process and postpartum hemorrhage)among three groups(all P>0.05).Logistic regression analysis showed that there was no significant correlation between infertility?r-AFS staging of endometriosis?pathological typing of endometriosis?the interval between laparoscopic surgery and postoperative pregnancy?unilateral or bilateral ovarian endometrial cyst,diameter of ovarian endometrial cyst>5 cm and adverse pregnancy outcomes in natural conception after laparoscopic surgery for endometriosis(all P>0.05).Conclusion:Pregnancy in patients with endometriosis,whether the pregnancy was obtained through ART or not,the risk of some adverse pregnancy outcomes is increased,and the adverse pregnancy outcomes could not be improved after laparoscopic surgery.And the r-AFS staging and pathological typing of endometriosis during surgery were not significantly related to the occurrence of adverse pregnancy outcomes after surgical treatment.However,compared with ovarian endometriosis alone,the risk of infertility and the interval between laparoscopic surgery and postoperative pregnancy were significantly increased in patients with ovarian and peritoneal endometriosis.Clinicians should strengthen obstetric care and psychological counseling for pregnant patients with endometriosis,and be more cautious in surgical treatment for endometriosis patients with fertility requirements.