fcmedicineФундаментальная и клиническая медицинаFundamental and Clinical Medicine2500-07642542-0941КемГМУ10.23946/2500-0764-2024-9-3-66-73fcmedicine-902Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL RESEARCHИсходы беременностей и родов у пациенток с эндометриоз-ассоциированным бесплодиемMaternal and newborn outcomes in patients with endometriosis-associated infertilityhttps://orcid.org/0000-0001-7816-9197ТищенкоЕ. Н.TishchenkoE. N.

Тищенко Екатерина Николаевна, врач акушер-гинеколог отделения патологии беременности

650066, Россия, г. Кемерово, Октябрьский пр-т, д. 22

Dr. Ekaterina N. Tishchenko, MD, Obstetrician-Gynecologist

22, Oktyabrsky Prospekt, Kemerovo,650066

Vaulina.en@mail.ruhttps://orcid.org/0000-0001-7014-6492АртымукН. В.ArtymukN. V.

Артымук Наталья Владимировна, доктор медицинских наук, профессор, заведующая кафедрой акушерства и гинекологии им. проф. Г. А. Ушаковой

650056, г. Кемерово, ул. Ворошилова, д. 22

Prof. Natalia V. Artymuk, MD, DSc, Professor, Head of the Department of Obstetrics and Gynecology named after G.A. Ushakova

22a, Voroshilova Street, Kemerovo, 650056

https://orcid.org/0000-0002-4991-5354ЗотоваО. А.ZotovaO. A.

Зотова Ольга Александровна, кандидат медицинских наук, врач акушер-гинеколог Центра охраны здоровья семьи и репродукции

650066, Россия, г. Кемерово, Октябрьский пр-т, д. 22

Dr. Olga A. Zotova, MD, PhD, Obstetrician-Gynecologist

22, Oktyabrsky Prospekt, Kemerovo, 650066

https://orcid.org/0000-0002-1272-401XДаниловаЛ. Н.DanilovaL. N.

Данилова Лариса Николаевна, кандидат медицинских наук, доцент кафедры акушерства и гинекологии им. проф. Г. А. Ушаковой

650056, г. Кемерово, ул. Ворошилова, д. 22а

Dr. Larisa N. Danilova, MD, PhD, Associate Professor, Department of Obstetrics and Gynecology named after G.A. Ushakova

22a, Voroshilova Street, Kemerovo, 650056

ГАУЗ «Кузбасская областная клиническая больница имени С. В. Беляева»РоссияBelyaev Kuzbass Clinical HospitalRussian FederationФБГОУ ВО «Кемеровский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияKemerovo State Medical UniversityRussian Federation202427092024936673Copyright © Тищенко Е.Н., Артымук Н.В., Зотова О.А., Данилова Л.Н., 20242024Тищенко Е.Н., Артымук Н.В., Зотова О.А., Данилова Л.Н.Tishchenko E.N., Artymuk N.V., Zotova O.A., Danilova L.N.This work is licensed under a Creative Commons Attribution 4.0 License.https://fcm.kemsmu.ru/jour/article/view/902Цель исследования

Цель исследования. Выявить особенности течения беременности и родов у женщин с эндометриоз-ассоциированным бесплодием (ЭАБ).

Материалы и методы

Материалы и методы. Дизайн исследования: ретроспективное, «случай-контроль». В исследование включено 115 женщин с гистологически верифицированным эндометриозом (I группа) и 250 женщин без этого заболевания (II группа). Статистическую обработку полученных результатов производили с помощью пакета прикладных программ IMB SPSS Statistics 20. Характер распределения данных оценивали с помощью критерия Колмогорова-Смирнова. Количественные данные представлены медианой (Me) и интерквартильным размахом (Q1 – Q3) с использованием критерия Манна – Уитни. Уровень статистической значимости при проверке нулевой гипотезы принимали соответствующий p < 0,05.

Результаты

Результаты. У пациенток с ЭАБ беременность статистически значимо чаще осложнялась предлежанием плаценты относительно пациенток группы сравнения − у 6 (5,2%) и 3 (1,2%) (р = 0,031). Пациентки с ЭАБ родоразрешены путем операции кесарева сечения в 49,6%, без ЭАБ – в 13,2% (p < 0,001). Роды у рожениц с ЭАБ статистически значимо чаще, чем у пациенток без ЭАБ, осложнялись слабостью родовой деятельности − в 7,0% и 6 (2,4%) (р = 0,043); задержкой частей последа/плодных оболочек − в 4,3% и 1 (0,4%) (р = 0,013), гипотоническим кровотечением – в 3,5% и 1 (0,4%) (р = 0,036). Исходы беременности и родов (состояние новорожденных) у женщин в I и II группах: вес новорожденного, оценка по шкале Апгар на 1-й и 5-й минуте, срок выписки из стационара, статистически значимо между группами не различались.

Заключение

Заключение. Для пациенток с эндометриоз-ассоциированным бесплодием характерно осложненное течение беременности и родов с более высокой частотой предлежания плаценты, аномалий родовой деятельности, гипотонического кровотечения, задержки частей плаценты и плодных оболочек, родоразрешения путем операции кесарева сечения, что требует разработки лечебно-профилактических мероприятий для предупреждения этих осложнений. Необходимы дальнейшие расширенные исследования в этом направлении.

Aim

Aim. To identify the characteristics of pregnancy and childbirth in women with endometriosis-associated infertility (EAI).

Materials and Methods

Materials and Methods. Here we performed retrospective case-control study which included 115 women with histologically verified endometriosis and 250 women without this condition. Statistical analysis was conducted using the IMB SPSS Statistics 20 software package. The data distribution was assessed using the Kolmogorov-Smirnov test. Quantitative data are presented as median (Me) and interquartile range (Q1 – Q3) using the Mann-Whitney test. The level of statistical significance for testing the null hypothesis was set at p < 0.05.

Results

Results. Pregnancy in patients with EAI was statistically significantly more often complicated by placenta previa compared to the control group: 6 (5.2%) versus 3 (1.2%) (p = 0.031). Patients with EAI were delivered via cesarean section in 49.6% of cases, compared to 13.2% in those without EAI (p < 0.001). Labor in women with EAI was statistically significantly more often complicated by uterine inertia (hypotonic labor, 7.0% versus 2.4% in those without EAI, p = 0.043), retained placenta (4.3% vs 0.4%, p = 0.013); and hypotonic bleeding (3.5% vs 0.4%, p = 0.036). Maternal and neonatal outcomes including birth weight, Apgar scores at 1 and 5 minutes, and the duration of hospital stay did not differ significantly between the groups.

Conclusions

Conclusions. Patients with EAI are characterized by a complicated course of pregnancy and childbirth with a higher incidence of placenta previa, abnormal labor, hypotonic bleeding, retained placenta, and cesarean delivery. Hence, the development of respective therapeutic and preventive measures is required to prevent these complications.

эндометриоз-ассоциированное бесплодиеосложнения беременности и родовпредлежание плацентызадержка частей плацентыгипотоническое кровотечениеendometriosis-associated infertilitymaternal and newborn outcomesplacenta previaretained placentahypotonic bleedingСобственные средства.None declared.ReferencesLeone Roberti Maggiore U., Ferrero S., Mangili G., Bergamini A., Inversetti A., Giorgione V., Viganò P., Candiani M. A systematic review on endometriosis during pregnancy: diagnosis, misdiagnosis, complications and outcomes. Hum. Reprod. Update. 2016;22(1):70−103. https://doi.org/10.1093/humupd/dmv045Leone Roberti Maggiore U, Ferrero S, Mangili G, Bergamini A, Inversetti A, Giorgione V, Viganò P, Candiani M. A systematic review on endometriosis during pregnancy: diagnosis, misdiagnosis, complications and outcomes. Hum Reprod Update. 2016;22(1):70−103. https://doi.org/10.1093/humupd/dmv045Артымук Н.В., Беженарь В.Ф., Берлим Ю.Д., Вовкочина М.А., Воронова О.В., Гимбут В.С., Дубровина С.О., Калугина А.С., Киревнина Л.В., Круглов С.Ю., Кузьмина Н.С., Левкович М.А., Маколкин А.А. Эндометриоз. Патогенез, диагностика, лечение. Москва : ГЭОТАР-Медиа, 2020.Artymuk NV, Bezhenar VF, Berlim YuD, Vovkochina MA, Voronova OV, Gimbut VS, Dubrovina SO, Kalugina AS, Kirevnina LVV, Kruglov SYu, Kuzmina NS, Levkovich MA, Makolkin AA. Jendometrioz. Patogenez, diagnostika, lechenie. Moscow : GEOTAR-Media, 2020. (In Russian).Li H., Zhu H.L., Chang X.H., Li Y., Wang Y., Guan J., Cui H. Effects of Previous Laparoscopic Surgical Diagnosis of Endometriosis on Pregnancy Outcomes. Chin. Med. J. (Engl). 2017;130(4):428−433. https://doi.org/10.4103/0366-6999.199840Li H, Zhu HL, Chang XH, Li Y, Wang Y, Guan J, Cui H. Effects of Previous Laparoscopic Surgical Diagnosis of Endometriosis on Pregnancy Outcomes. Chin. Med. J. (Engl). 2017;130(4):428-433. https://doi.org/10.4103/0366-6999.199840Zullo F., Spagnolo E., Saccone G., Acunzo M., Xodo S., Ceccaroni M., Berghella V. Endometriosis and obstetrics complications: a systematic review and meta-analysis. Fertil. Steril. 2017;108(4):667−672.e5. https://doi.org/10.1016/j.fertnstert.2017.07.019Zullo F, Spagnolo E, Saccone G, Acunzo M, Xodo S, Ceccaroni M, Berghella V. Endometriosis and obstetrics complications: a systematic review and meta-analysis. Fertil Steril. 2017;108(4):667−672.e5. https://doi.org/10.1016/j.fertnstert.2017.07.019Miura M., Ushida T., Imai K., Wang J., Moriyama Y., Nakano-Kobayashi T., Osuka S., Kikkawa F., Kotani T. Adverse effects of endometriosis on pregnancy: a case-control study. BMC Pregnancy Childbirth. 2019;19(1):373. https://doi.org/10.1186/s12884-019-2514-1Miura M, Ushida T, Imai K, Wang J, Moriyama Y, Nakano-Kobayashi T, Osuka S, Kikkawa F, Kotani T. Adverse effects of endometriosis on pregnancy: a case-control study. BMC Pregnancy Childbirth. 2019;19(1):373. https://doi.org/10.1186/s12884-019-2514-1Farland L.V., Prescott J., Sasamoto N., Tobias D.K., Gaskins A.J., Stuart J.J., Carusi D.A., Chavarro J.E., Horne A.W., Rich-Edwards J.W., Missmer S.A. Endometriosis and Risk of Adverse Pregnancy Outcomes. Obstet. Gynecol. 2019;134(3):527−536. https://doi.org/10.1097/AOG.0000000000003410Farland LV, Prescott J, Sasamoto N, Tobias DK, Gaskins AJ, Stuart JJ, Carusi DA, Chavarro JE, Horne AW, Rich-Edwards JW, Missmer SA. Endometriosis and Risk of Adverse Pregnancy Outcomes. Obstet Gynecol. 2019;134(3):527−536. https://doi.org/10.1097/AOG.0000000000003410Jeon H., Min J., Kim D.K., Seo H., Kim S., Kim Y.S. Women with Endometriosis, Especially Those Who Conceived with Assisted Reproductive Technology, Have Increased Risk of Placenta Previa: Meta-analyses. J. Korean Med. Sci. 2018;33(34):e234. https://doi.org/10.3346/jkms.2018.33.e234Jeon H, Min J, Kim DK, Seo H, Kim S, Kim YS. Women with Endometriosis, Especially Those Who Conceived with Assisted Reproductive Technology, Have Increased Risk of Placenta Previa: Meta-analyses. J Korean Med Sci. 2018;33(34):e234. https://doi.org/10.3346/jkms.2018.33.e234Yi K.W., Cho G.J., Park K., Han S.W., Shin J.H., Kim T., Hur J.Y. Endometriosis Is Associated with Adverse Pregnancy Outcomes: a National Population-Based Study. Repro Sci. 2020;27(5):1175−1180. https://doi.org/10.1007/s43032-019-00109-1PMID:31953772Yi KW, Cho GJ, Park K, Han SW, Shin JH, Kim T, Hur JY. Endometriosis Is Associated with Adverse Pregnancy Outcomes: a National Population-Based Study. Repro Sci. 2020;27(5):1175−1180. https://doi.org/10.1007/s43032-019-00109-1PMID:31953772Kolanska K., Alijotas-Reig J., Cohen J. Cheloufi M., Selleret L., d'Argent E., Kayem G., Valverde E.E., Fain O., Bornes M., Darai E., Mekinian A. Endometriosis with infertility: A comprehensive review on the role of immune deregulation and immunomodulation therapy. Am. J. Reprod. Immunol. 2021;85(3):e13384. https://doi.org/10.1111/aji.13384Kolanska K, Alijotas-Reig J, Cohen J, Cheloufi M, Selleret L, d'Argent E, Kayem G, Valverde EE, Fain O, Bornes M, Darai E, Mekinian A. Endometriosis with infertility: A comprehensive review on the role of immune deregulation and immunomodulation therapy. Am J Reprod Immunol. 2021;85(3):e13384. doi:10.1111/aji.13384Benaglia L., Candotti G., Papaleo E., Pagliardini L., Leonardi M., Reschini M., Quaranta L., Munaretto M., Viganò P., Candiani M., Vercellini P., Somigliana E. Pregnancy outcome in women with endometriosis achieving pregnancy with IVF. Hum. Reprod. 2016;31(12):2730−2736. https://doi.org/10.1093/humrep/dew210Benaglia L, Candotti G, Papaleo E, Pagliardini L, Leonardi M, Reschini M, Quaranta L, Munaretto M, Viganò P, Candiani M, Vercellini P, Somigliana E. Pregnancy outcome in women with endometriosis achieving pregnancy with IVF. Hum Reprod. 2016;31(12):2730−2736. https://doi.org/10.1093/humrep/dew210Porpora M.G., Tomao F., Ticino A., Piacenti I., Scaramuzzino S., Simonetti S., Imperiale L., Sangiuliano C., Masciullo L., Manganaro L., Benedetti Panici P. Endometriosis and Pregnancy: A Single Institution Experience. Int. J. Environ. Res. Public. Health. 2020;17(2):401. https://doi.org/10.3390/ijerph17020401Porpora MG, Tomao F, Ticino A, Piacenti I, Scaramuzzino S, Simonetti S, Imperiale L, Sangiuliano C, Masciullo L, Manganaro L, Benedetti Panici P. Endometriosis and Pregnancy: A Single Institution Experience. Int J Environ Res Public Health. 2020;17(2):401. https://doi.org/10.3390/ijerph17020401Vercellini P., Viganò P., Bandini V., Buggio L., Berlanda N., Somigliana E. Association of endometriosis and adenomyosis with pregnancy and infertility. Fertil. Steril. 2023;119(5):727−740. https://doi.org/10.1016/j.fertnstert.2023.03.018Vercellini P, Viganò P, Bandini V, Buggio L, Berlanda N, Somigliana E. Association of endometriosis and adenomyosis with pregnancy and infertility. Fertil Steril. 2023;119(5):727−740. https://doi.org/10.1016/j.fertnstert.2023.03.018Matsuzaki S., Nagase Y., Ueda Y., Lee M., Matsuzaki S., Maeda M., Takiuchi T., Kakigano A., Mimura K., Endo M., Tomimatsu T., Kimura T. The association of endometriosis with placenta previa and postpartum hemorrhage: a systematic review and meta-analysis. Am. J. Obstet. Gynecol. MFM. 2021;3(5):100417. https://doi.org/10.1016/j.ajogmf.2021.10041713Matsuzaki S, Nagase Y, Ueda Y, Lee M, Matsuzaki S, Maeda M, Takiuchi T, Kakigano A, Mimura K, Endo M, Tomimatsu T, Kimura T. The association of endometriosis with placenta previa and postpartum hemorrhage: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2021;3(5):100417. https://doi.org/10.1016/j.ajogmf.2021.100417Matsuzaki S., Nagase Y., Ueda Y., Kakuda M., Maeda M., Matsuzaki S., Kamiura S. Placenta Previa Complicated with Endometriosis: Contemporary Clinical Management, Molecular Mechanisms, and Future Research Opportunities. Biomedicines. 2021;9(11):1536. https://doi.org/10.3390/biomedicines9111536Matsuzaki S, Nagase Y, Ueda Y, Kakuda M, Maeda M, Matsuzaki S, Kamiura S. Placenta Previa Complicated with Endometriosis: Contemporary Clinical Management, Molecular Mechanisms, and Future Research Opportunities. Biomedicines. 2021;9(11):1536. https://doi.org/10.3390/biomedicines9111536Gasparri M.L., Nirgianakis K., Taghavi K., Papadia A., Mueller M.D. Placenta previa and placental abruption after assisted reproductive technology in patients with endometriosis: a systematic review and meta-analysis. Arch. Gynecol. Obstet. 2018;298(1):27−34. https://doi.org/10.1007/s00404-018-4765-xGasparri ML, Nirgianakis K, Taghavi K, Papadia A, Mueller MD. Placenta previa and placental abruption after assisted reproductive technology in patients with endometriosis: a systematic review and meta-analysis. Arch Gynecol Obstet. 2018;298(1):27−34. https://doi.org/10.1007/s00404-018-4765-xMatsuzaki S., Ueda Y., Nagase Y., Matsuzaki S., Kakuda M., Kakuda S., Sakaguchi H., Hisa T., Kamiura S. Placenta Accreta Spectrum Disorder Complicated with Endometriosis: Systematic Review and Meta-Analysis. Biomedicines. 2022;10(2):390. https://doi.org/10.3390/biomedicines10020390Matsuzaki S, Ueda Y, Nagase Y, Matsuzaki S, Kakuda M, Kakuda S, Sakaguchi H, Hisa T, Kamiura S. Placenta Accreta Spectrum Disorder Complicated with Endometriosis: Systematic Review and Meta-Analysis. Biomedicines. 2022;10(2):390. https://doi.org/10.3390/biomedicines10020390Vercellini P., Parazzini F., Pietropaolo G., Cipriani S., Frattaruolo M.P., Fedele L. Pregnancy outcome in women with peritoneal, ovarian and rectovaginal endometriosis: a retrospective cohort study. BJOG. 2012;119(12):1538−43. https://doi.org/10.1111/j.1471-0528.2012.03466.xVercellini P, Parazzini F, Pietropaolo G, Cipriani S, Frattaruolo MP, Fedele L. Pregnancy outcome in women with peritoneal, ovarian and rectovaginal endometriosis: a retrospective cohort study. BJOG. 2012;119(12):1538−43. https://doi.org/10.1111/j.1471-0528.2012.03466.xChapron C., Tosti C., Marcellin L., Bourdon M., Lafay-Pillet M.C., Millischer A.E., Streuli I., Borghese B., Petraglia F., Santulli P. Relationship between the magnetic resonance imaging appearance of adenomyosis and endometriosis phenotypes. Hum. Reprod. 2017;32(7):1393−1401. https://doi.org/10.1093/humrep/dex088Chapron C, Tosti C, Marcellin L, Bourdon M, Lafay-Pillet MC, Millischer AE, Streuli I, Borghese B, Petraglia F, Santulli P. Relationship between the magnetic resonance imaging appearance of adenomyosis and endometriosis phenotypes. Hum Reprod. 2017;32(7):1393−1401. https://doi.org/10.1093/humrep/dex088.Marcellin L., Santulli P., Bourdon M., Maignien C., Campin L., Lafay-Pillet M.C., Millischer A.E., Bordonne C., Borghese B., Dousset B., Chapron C. Focal adenomyosis of the outer myometrium and deep infiltrating endometriosis severity. Fertil. Steril. 2020;114(4):818−827. https://doi.org/10.1016/j.fertnstert.2020.05.003Marcellin L, Santulli P, Bourdon M, Maignien C, Campin L, Lafay-Pillet MC, Millischer AE, Bordonne C, Borghese B, Dousset B, Chapron C. Focal adenomyosis of the outer myometrium and deep infiltrating endometriosis severity. Fertil Steril. 2020;114(4):818−827. https://doi.org/10.1016/j.fertnstert.2020.05.003Berlanda N., Alio W., Angioni S., Bergamini V., Bonin C., Boracchi P., Candiani M., Centini G., D'Alterio M.N., Del Forno S., Donati A., Dridi D., Incandela D., Lazzeri L., Maiorana A., Mattei A., Ottolina J., Orenti A., Perandini A., Perelli F., Piacenti I., Pino I., Porpora M.G., Scaramuzzino S., Seracchioli R., Solima E., Somigliana E., Venturella R., Vercellini P., Viganò P., Vignali M., Zullo F., Zupi E.; Endometriosis Treatment Italian Club (ETIC). Impact of endometriosis on obstetric outcome after natural conception: a multicenter Italian study. Arch. Gynecol. Obstet. 2022;305(1):149−157. https://doi.org/10.1007/s00404-021-06243-zBerlanda N, Alio W, Angioni S, Bergamini V, Bonin C, Boracchi P, Candiani M, Centini G, D'Alterio MN, Del Forno S, Donati A, Dridi D, Incandela D, Lazzeri L, Maiorana A, Mattei A, Ottolina J, Orenti A, Perandini A, Perelli F, Piacenti I, Pino I, Porpora MG, Scaramuzzino S, Seracchioli R, Solima E, Somigliana E, Venturella R, Vercellini P, Viganò P, Vignali M, Zullo F, Zupi E; Endometriosis Treatment Italian Club (ETIC). Impact of endometriosis on obstetric outcome after natural conception: a multicenter Italian study. Arch Gynecol Obstet. 2022;305(1):149−157.https://doi.org/10.1007/s00404-021-06243-zGlavind M.T., Forman A., Arendt L.H., Nielsen K., Henriksen T.B. Endometriosis and pregnancy complications: a Danish cohort study. Fertil. Steril. 2017;107(1):160−166. https://doi.org/10.1016/j.fertnstert.2016.09.020Glavind MT, Forman A, Arendt LH, Nielsen K, Henriksen TB. Endometriosis and pregnancy complications: a Danish cohort study. Fertil Steril. 2017;107(1):160−166. https://doi.org/10.1016/j.fertnstert.2016.09.020Berlac J.F., Hartwell D., Skovlund C.W., Langhoff-Roos J., Lidegaard Ø. Endometriosis increases the risk of obstetrical and neonatal complications. Acta Obstet. Gynecol. Scand. 2017;96(6):751−760. https://doi.org/10.1111/aogs.13111Berlac JF, Hartwell D, Skovlund CW, Langhoff-Roos J, Lidegaard Ø. Endometriosis increases the risk of obstetrical and neonatal complications. Acta Obstet Gynecol Scand. 2017;96(6):751−760. https://doi.org/10.1111/aogs.13111Lalani S., Choudhry A.J., Firth B., Bacal V., Walker M., Wen S.W., Singh S., Amath A., Hodge M., Chen I. Endometriosis and adverse maternal, fetal and neonatal outcomes, a systematic review and meta-analysis. Hum. Reprod. 2018;33(10):1854−1865. https://doi.org/10.1093/humrep/dey269Lalani S, Choudhry AJ, Firth B, Bacal V, Walker M, Wen SW, Singh S, Amath A, Hodge M, Chen I. Endometriosis and adverse maternal, fetal and neonatal outcomes, a systematic review and meta-analysis. Hum Reprod. 2018;33(10):1854−1865. https://doi.org/10.1093/humrep/dey269Conti N., Cevenini G., Vannuccini S., Orlandini C., Valensise H., Gervasi M.T., Ghezzi F., Di Tommaso M., Severi F.M., Petraglia F. Women with endometriosis at first pregnancy have an increased risk of adverse obstetric outcome. J. Matern. Fetal. Neonatal. Med. 2015;28(15):1795−8. https://doi.org/10.3109/14767058.2014.968843Conti N, Cevenini G, Vannuccini S, Orlandini C, Valensise H, Gervasi MT, Ghezzi F, Di Tommaso M, Severi FM, Petraglia F. Women with endometriosis at first pregnancy have an increased risk of adverse obstetric outcome. J Matern Fetal Neonatal Med. 2015;28(15):1795−8. https://doi.org/10.3109/14767058.2014.968843.

The authors declare that there are no conflicts of interest present.