A new study by the Canadian Association of Midwives found a strong link between endometriosis and obstetric morbidity.
Shira, 44 years old, married and mother of three, has been diagnosed with endometriosis and adenomyosis for 20 years. Her entire pregnancy ended with severe preeclampsia that struck her after the birth, and the doctors could not pinpoint what caused it. In her second and third pregnancy, she was already defined as a high-risk pregnancy and despite frequent follow-up and repeatedly asking if there might be a connection to endometriosis, she answered that there was nothing to do with the disease she was diagnosed with.
Endometriosis is a gynecological, inflammatory, chronic disease, very common especially in the childbearing age. This disease is characterized by cells similar to endometrial cells, which are outside the uterus mainly in the pelvis. The cells stick to different organs in the pelvis and create inflammation around them. This causes infections, pain, damage to organs and sometimes even results in infertility.
March is Endometriosis Awareness Month. In this month, it is customary in all countries of the world to act to raise awareness of the disease in order to contribute to the early diagnosis of endometriosis among women who suffer from the disease and have not yet been diagnosed. The Israel Endometriosis Association works a lot to raise awareness of the disease, promote rights and its treatment. The association operates support and knowledge communities and initiates conferences and lectures on the subject in collaboration with experts.
In the past it was thought that pregnancy could cure endometriosis. This is a false myth that originates from the fact that sometimes during pregnancy there will be a respite from the disease and symptoms. Many times, endometriosis patients will actually experience worsening symptoms in the first trimester, most likely due to the growth of the uterus and the creation of pressure on existing foci and adhesions. In most cases, in the second and third trimesters of pregnancy, there will be a benefit since the uterus comes out of the pelvis and there is less tension on the ligaments that hold the uterus and less pressure on the foci and adhesions.
A new study carried out in Canada examined 2.5 million births in hospital records in Quebec in the years 1989-2019. The study showed that mothers who suffered from worsening endometriosis during pregnancy were at a higher risk of obstetric complications.
Endometriosis with symptoms during pregnancy increased the risk 1.5 times for severe obstetric and maternal morbidity including preeclampsia, bleeding and more. This, while a pregnancy of an endometriosis patient that is not accompanied by symptoms of the disease during pregnancy did not cause these results.
The results of the study clearly confirmed that endometriosis is a greater risk factor for severe obstetric morbidity. The conclusion is that in pregnant endometriosis patients, especially severe endometriosis and with pregnancy symptoms, there is a higher risk of maternal and obstetric morbidity and therefore close follow-up is necessary to prevent severe complications in pregnancy and, if there are, to identify them as early as possible and treat them.
Another study carried out in Israel at the Medical Center for Endometriosis in “Sheba” under the leadership of Dr. Michal Zicek, a leading expert in the field of ultrasound for endometriosis, followed findings and lesions during pregnancy and after childbirth. In the prospective study conducted between 2018-2021, 28 women participated. The study followed After pregnant women with findings of endometriosis including endometriomas. The women underwent an ultrasound examination once per trimester and another ultrasound examination after delivery, if lesions/endometriomas were found, their size was checked. The study found that deep lesions and endometriomas undergo change, and in many cases grow during pregnancy, in a process called decidualization. In most cases after birth, the lesions return to their original size before pregnancy.
These studies led to the understanding that there is a need for special follow-up for pregnant endometriosis patients, especially in cases of complex and severe disease due to the increased risk of morbidity and obstetric complications.
“Women with endometriosis are at a higher risk of obstetrical complications such as: preeclampsia, placenta previa, premature birth and more,” said Dr. Elad Berkovich, director of the endometriosis center at the Sheba Hospital in Tel Hashomer. “That is why they need close monitoring during pregnancy, In order to identify complications ahead of time and treat them as early as possible.”