Endometriosis linked to increased placenta previa incidence in pregnant women

Key takeaways:

• Women with more severe endometriosis had higher placenta previa incidence vs. women with less severe disease.
• There was no significant difference in other pregnancy complications between disease severity groups.

Among pregnant women, endometriosis was associated with increased placenta previa incidence that correlated with disease severity, researchers reported in the European Review for Medical and Pharmacological Sciences.

“While pregnancy-related changes in immune regulation, in addition to fluctuations in hormones and metabolism, and increased angiogenesis, cause the ectopic endometrium to shrink in response to a lack of estrogen support, studies show that endocrine environment of pregnancy does not prevent the progression of endometriosis,” Zhao-zhen Liu, MD, from the department of obstetrics and gynecology at the College of Clinical Medicine for Obstetrics, Gynecology and Pediatrics at Fujian Medical University, China, and colleagues wrote. “Studies have also suggested that endometriosis may negatively affect pregnancy, increasing the risks of preeclampsia, intrauterine growth restriction, abnormal placental position, pre- and postpartum hemorrhage, as well as increased risk of delivery by cesarean section.”

Liu and colleagues conducted a retrospective study with 3,809 women who were examined, hospitalized and underwent cesarean delivery at Fujian Maternal and Child Health Hospital from 2014 to 2020. The 1,026 women with endometriosis following cesarean delivery were compared with those without. Women with endometriosis were also further categorized into subgroups based on disease severity, with 882 women with stage I or II endometriosis and 144 women with stage III or IV endometriosis.

Researchers observed no statistically significant differences in the age, gestational age, gestation and parity times between endometriosis and control groups. Postpartum hemorrhage and placenta previa incidence among women with endometriosis was higher compared with the control group. Chronic hypertension with pregnancy, preeclampsia with chronic hypertension, hemolysis, elevated liver enzymes and low platelets syndrome, gestational diabetes, intrahepatic cholestasis of pregnancy, premature rupture of membranes or placental abruption rates were not significantly different between women with endometriosis and women without.

Women with endometriosis had a higher amount of postpartum hemorrhage compared with the control group (P < .001). Researchers noted, however, that there was no significant difference in postpartum hemorrhage incidence among women with endometriosis at different stages.

Women with stage III or IV endometriosis had higher placenta previa incidence compared with women with stage I or II (P < .001). No significant differences in other pregnancy complication incidences were observed between disease severity groups.