Pregnancy and delivery outcomes in women with rectovaginal endometriosis treated either conservatively or operatively

Abstract

Objective: To study reproductive outcomes, and pregnancy and delivery complications after conservative or operative treatment of rectovaginal endometriosis during long-term follow-up.

Design: Retrospective cohort study.

Setting: University hospital.

Patient(s): Women with rectovaginal endometriosis referred to hospital due to any indication from 2004 to 2013 (N = 543) who were treated initially either conservatively (group CONS, n = 183), or operatively (OPER, n = 360) either with resection of rectovaginal nodule (RVR, n = 192) or with concomitant bowel resection (BR, n = 132).

Intervention(s): Conservative or operative management.

Main outcome measure(s): Clinical pregnancy rate, live-birth rate, and assessment of the complications during pregnancy and delivery.

Results(s): Between women in the CONS group or OPER group, no differences were found in either clinical pregnancy rate (56%, n = 102 vs. 50%, n = 181) or live-birth rate (48%, n = 87 vs. 42%, n = 153). Of the pregnancies, 64% (n = 65) and 49% (n = 89), respectively, started after medically assisted reproduction. No differences emerge in the subanalysis of women <40 years-old who wished to conceive. The most common pregnancy complication was preterm birth: 15% (n = 13) in the CONS group and 20% (n = 30) in the OPER group. The cesarean delivery rate also was high (46%, n = 40 vs. 49%, n = 76). Complications emerged in 21% (n = 10) versus 29% (n = 23) of vaginal deliveries and 45% (n = 18) versus 53% (n = 40) of cesarean deliveries. The most common delivery complication was excessive bleeding. The follow-up period was 4.9 years in the CONS group and 5.6 years in the OPER group.

Conclusion(s): Women with rectovaginal endometriosis have comparable and good reproductive prognosis regardless of the treatment method.

Keywords: Delivery complication; fertility; pregnancy complication; rectovaginal endometriosis.