Obstetric and perinatal outcome in women with endometriosis 2022 TOG

Question 1

What % women have endometriosis

Answer 1

10%

Question 2

How many women with endometriosis with present with sub fertility

Answer 2

30%

Question 3

Obstetric outcomes associate with endometriosis

Answer 3

spontaneous miscarriage (include ectopic), pre-eclampsia, postpartum haemorrhage, caesarean section, placenta praevia, fetal growth restriction, prematurity and adverse neonatal outcomes.

Question 4

If low risk endometriosis group how to be managed>

Answer 4

Low risk pregnancy

Question 5

Which are considered high risk endometriosis

Answer 5

Adenomyosis
Conceived by ART
Surgically treated severe peritoneal disease
DIE - rectovaignal nodules
Bowel and bladder endometriosis

Question 6

Preconception counselling for higher risk endometriosis

Answer 6

Increased risk Misc, PIH, PET, SGA, PTD, placenta praevia, CS, PPH, neonatal admission
Increased risk 3rd/4th if rectovaginal Endometritis
Risk increase size, rupture and abscess formation of endometriomas - mimicking malignancy

Question 7

AN Care for high risk endometriosis

Answer 7

Cons led care
BP monitoring
Consider aspirin
Endometrioma surveillence
Regular growth assessement

Question 8

Intrapartum care for high risk endometriosis

Answer 8

IV access FBC & G&S
Cont CTG
Increased risk failed IOL/obstructed labour
Early reserve CS if abdo pain, hypotension, haemturia
Senior Obs at CS if previous extensively surgically treated Endometritis

Question 9

Postpartum care for high risk endometriosis

Answer 9

Risk PPH & MROP
Risk neonatal admission
PN torsion of large ovarian endometriomas