The effect of hormone-modulating therapy during pregravid preparation on the course of pregnancy and childbirth in patients with a history of endometriosis

BACKGROUND: Endometriosis is a benign proliferation of tissue similar in morphological and functional characteristics with endometrium outside the uterine. In the structure of gynecological diseases, it ranks on the third place and its prevalence is growing steadily every year.

AIM: The aim of this study was to analyze the features of pregnancy and childbirth in patients with endometriosis who received hormone-modulating therapy during pregravid preparation.

MATERIALS AND METHODS: This retrospective analysis of the course of pregnancy and childbirth in patients with a surgically confirmed diagnosis of varying severity endometriosis (n = 140) in history was carried out at the Center for Diagnosis and Treatment of Endometriosis, The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott, Saint Petersburg, Russia. The control group consisted of pregnant women without endometriosis (n = 50).

RESULTS: Before pregnancy, 82.1% (n = 115) of patients with endometriosis used hormone-modulating therapy, while 17.9% (n = 15) of patients did not comply with the given therapy. During therapy, 70% (n = 98) of patients mentioned decreasing in the severity of pain. In patients with a history of endometriosis, threatened miscarriage took the leading place and was identified in 24.3% of cases in the first and second trimesters and in 33.6% of cases in the third trimester of pregnancy, which was consistently higher than in the control group. Miscarriage was observed in 38.5% of patients and recurrent pregnancy loss in 18.6% of women. Preeclampsia was diagnosed in 23.8% (n = 33) of patients with endometriosis. The use of hormone-modulating therapy during pregravid preparation was shown to reduce the risk of developing preeclampsia among patients with endometriosis by 4.1 times, and the use of dienogest 2 mg as the therapy of endometriosis to reduce the frequency of preeclampsia by ten times in comparison with patients who did not receive any treatment. Fetal growth restriction was observed in 18.6% (n = 26) of patients with endometriosis. The presence of endometriosis increased the likelihood of developing fetal growth restriction by 3.6 times and reduced the likelihood of having a large fetus by 2.7 times. Preterm birth was observed in 20% (n = 28) of patients with endometriosis, which is four times higher than in the control group (p = 0.019). Most pregnant women with a history of endometriosis – 64.3 % (n = 90) of patients – were delivered by cesarean section, while 35.7% (n = 50) of women had vaginal birth, which was 3.34 times higher than the frequency of cesarean section in the control group.

CONCLUSIONS: Patients with a history of endometriosis are at high risk for the development of obstetric complications associated with the pathogenesis of the disease. An integrated approach to the treatment of endometriosis with the use of hormone-modulating therapy during pregravid preparation and personalized management of patients in different trimesters of pregnancy can reduce the risk of complications of pregnancy and childbirth.