Endometriosis, or a history of surgery for the condition, can cause rare but severe complications during pregnancy and delivery — a risk physicians need to be aware of.
The study, “Endometriosis-associated Maternal Pregnancy Complications – Case Report and Literature Review,” published in the German journal Geburtshilfe Frauenheilkunde, illustrated this fact by presenting two case reports of women needing acute surgery during pregnancy.
The cases, along with a review of previously published studies, underscore the importance of looking into the medical history of patients who can present with symptoms difficult to diagnose. The researchers, with the Women’s Hospital at the Karlsruhe City Hospital, also suggest that fiber optics be used to explore the cause of symptoms in pregnant women, and that physicians might need to consider cesarean sections, particularly when a pregnancy is in advanced stages.
Serious complications of endometriosis or its surgery are most often seen in women with a form of the disease where endometriotic lesions are found deep within other tissue. A 33-year-old woman, who had extensive surgery five years earlier and who already had one child, came to the hospital with severe pain on the left side of the stomach. Ultrasound revealed a shape that looked like bleeding and doctors suspected she had a hemorrhagic ovarian cyst.
Using fiber optics, they saw that the left ovary and fallopian tubes were darkened and enlarged, and adhered both to the pelvis and the last part of the intestines. When doctors managed to detach it, they realized that it was twisted several times. Since it was impossible to untwist, they operated to remove the ovary and fallopian tube, although the procedure is raises the risk of death for the fetus. The woman and her unborn child came through the surgery well, and she returned home after four days and later gave birth via cesarean section without further complications.
In the second case, a 27-year-old woman in the 27th week of her pregnancy came to the hospital bleeding from the vagina and having preterm labor. Physicians could not identify the source of the bleeding, but with the help of medications, they managed to stop both the early contractions and the bleeding.
One week later, the woman came back, again bleeding heavily. Doctors suspected that the placenta had detached from the wall of the womb, but could not find evidence of that using ultrasound. The pain increased to extreme levels, and the blood circulation became unstable, although the bleeding had stopped.
Since doctors considered the condition life-threatening, they delivered the child by cesarean section. The woman’s gut cavity was filled with blood and once the baby was delivered, researchers found several points of bleeding from membranes on the uterus and rectum. The uterus had also been attached to the intestines. This attachment had ruptured, also contributing to the bleeding. After closing the wounds, the woman recovered and returned home five days after surgery.
Although rare, the symptoms these women experienced are typical of pregnancy complications in women with endometriosis. Because of the rarity, the authors state that general recommendations are not possible to make.
“Elective caesarean section may be indicated for both completely operated endometriosis and incompletely operated, deep infiltrating endometriosis. However, a general recommendation can not be made,” they concluded.