Deep Infiltrating Endometriosis and Adenomyosis: Implications on Pregnancy and Outcome

Abstract

Endometriosis (EM), especially deep infiltrating endometriosis (DIE) and adenomyosis (AM), are known to cause pain and sterility in young women. More recently, they have also been described as risk factors for obstetric complications. While the pathophysiology is not yet completely understood, they seem to share a common origin: archimetrosis. Methods: A systematic literature review was conducted to summarize the existing evidence on DIE and AM as risk factors for obstetric complications. Results: Preterm birth, caesarean section delivery (CS) and placental abnormalities are associated with the diagnosis of DIE and AM. Women with AM seem to experience more often hypertensive pregnancy disorders, premature rupture of membranes and their children are born with lower birth weights than in the control groups. However, many of the studies tried to evaluate AM, EM and DIE as separate risk factors. Moreover, often they did not adjust for important confounders such as multiple pregnancies, parity, mode of conception and maternal age. Therefore, prospective studies with larger numbers of cases and appropriate adjustment for confounders are needed to explore the pathophysiology and to prove causality.

Keywords: adenomyosis; archimetrosis; deep infiltrating endometriosis; pregnancy outcome.

Figure 1

Women with archimetrosis develop functional and structural changes of the uterus over time. When the desire to have children arises the uterine function may be impaired and symptoms such as sterility and early abortions are commonly observed. Even if pregnancy is achieved spontaneously, or more likely with the help of IVF, it may be associated with complications such as preterm birth, placental problems, early rupture of membranes, pre-eclampsia, hypertension, and a higher rate of CS.

Figure 2

PRISMA diagram.