Endometriosis impact on the course of pregnancy and obstetric outcomes





endometriosis, course of pregnancy, obstetric outcomes


Today, the issues of the pregnancy course in women with endometriosis and endometriosis impact on obstetric outcome remain unresolved and insufficiently studied.
Research objective: to study the association between endometriosis and pregnancy complications, adverse obstetric outcomes.
Materials and methods. A retrospective cohort study comparing the incidence of pregnancy complications and adverse obstetric outcomes in 478 women with endometriosis (main group) and 544 women without endometriosis (control group). Complications of pregnancy and unfavorable obstetric outcomes were assessed, such as spontaneous miscarriage, ectopic pregnancy, vomiting of pregnant women, premature birth, caesarean section, pathological attachment of the placenta, postpartum hemorrhage and small for gestational age fetuses.
Results. The study showed that pregnant women with endometriosis have an increased risk of spontaneous miscarriages compared to the control group: 89/478 (19.07 ± 1.13%) versus 87/544 (14.93 ± 0.49%) respectively (p < 0.001), ectopic pregnancy: 12/478 (2.84 ± 0.47%) versus 5/544 (0.97 ± 0.36%) respectively (p < 0.001); vomiting of pregnant women: 86/478 (17.85 ± 1.09%) compared with 16/544 (3.15 ± 0.34%) respectively (p < 0.001); premature birth: 72/478 (15.5 ± 1.03%) versus 55/544 (10.17 ± 0.30%) respectively (p < 0.001); increased frequency of caesarean section: 99/478 (20.44 ± 1.24%) versus 87/544 (15.5 ± 0.73%) respectively (p < 0.001) and pathological attachment of the placenta: 19/478 (4.31 ± 0.59%) versus 8/544 (1.46 ± 0.30%) respectively (p < 0.001).
There was no association between endometriosis and postpartum hemorrhage and small gestational age of the fetus.
Conclusions. Pregnant women with endometriosis have an increased risk of spontaneous miscarriages, ectopic pregnancy, vomiting of pregnant women, premature birth, caesarean section, pathological attachment of the placenta. The association established in our study between endometriosis and complications of pregnancy, unfavorable obstetric results requires further research to clarify the mechanisms of the results obtained.

Author Biographies

L.A. Zhabitska, O.O. Bogomolets National Medical University; Kyiv City Perinatal Center, Kyiv

PhD, assistant, Obstetrics and Gynecology Department № 1;

L.A. Zhabitska, Medical center “Boris”, Medical center “Dobrobut”, Kyiv

PhD, obstetrician-gynecologist


  1. Agic, A., et al. “Is endometriosis associated with systemic subclinical inflammation?” Gynecol Obstet Invest 62.3 (2006): 139–47.
  2. Agostinis, C., Balduit, A., Mangogna, A., et al. “Immunological Basis of the Endometriosis: The Complement System as a Potential Therapeutic Target.” Front Immunol 11 (2020). DOI: 10.3389/fimmu.2020.599117
  3. Ahn, S.H., Monsanto, S.P., Miller, C., et al. “Pathophysiology and Immune Dysfunction in Endometriosis.” BioMed Res Int (2015). DOI: 10.1155/2015/795976
  4. Baranao, I.R. “Endometriosis. Why is not removed by immune system?” Ginecol Obstet Mex 82 (2014): 755–63.
  5. Forte, A., Cipollaro, M., Galderisi, U. “Genetic, epigenetic and stem cell alterations in endometriosis: new insights and potential therapeutic perspectives.” Clin Sci (Lond) 126.2 (2014): 123–38.
  6. Fox, C., et al. “Local and systemic factors and implantation: what is the evidence?” Fertil Steril 105 (2016): 873–84.
  7. Giuliani, E., Parkin K.L., Lessey B.A., et al. “Characterization of uterine NK cells in women with infertility or recurrent pregnancy loss and associated endometriosis.” Am J Reprod Immunol 72.3 (2014): 262–69.
  8. Grandi, G., et al. “Inflammation influences steroid hormone receptors targeted by progestins in endometrial stromal cells from women with endometriosis.” J Reprod Immunol 117 (2016): 30–8.
  9. Izumi, G., Koga, K., Takamura, M., et al. “Involvement of immune cells in the pathogenesis of endometriosis.” J Obstet Gynaecol Res 44.2 (2018): 191–98.
  10. Jerman, L.F., Hey-Cunningham, A.J. “The role of the lymphatic system in endometriosis: a comprehensive review of the literature.” Biol Reprod 92.3 (2015): 64.
  11. Koninckx, P.R., Ussia A., Adamyan L., Wattiez A. “Pathogenesis of endometriosis: the genetic/epigenetic theory.” Fertil Steril 111.2 (2019): 327–40.
  12. Lagana, A.S., Garzon, S., Gotte, M., et al. “The Pathogenesis of Endometriosis: Molecular and Cell Biology Insights.” Int J Mol Sci 20.22 (2019). DOI: 10.3390/ijms20225615
  13. Leeners, B., Farquhar, C.M. “Benefits of pregnancy on endometriosis: can we dispel the myths?” Fertil Steril 112.2 (2019): 226–27.
  14. Lessey, B.A., et al. “Endometrial receptivity in the eutopic endometrium of women with endometriosis.” Fertil Steril 108.1 (2017): 19–27.
  15. Li, F., Alderman, M.H., Tal, A., et al. “Hematogenous Dissemination of Mesenchymal Stem Cells from Endometriosis.” Stem Cells 36.6 (2018): 881–90.
  16. Miller, J.E., Ahn, S.H., Monsanto, S.P., et al. “Implications of immune dysfunction on endometriosis associated infertility.” Oncotarget 8.4 (2017): 7138–7147.
  17. Monsanto, S.P., et al. “Surgical removal of endometriosis lesions alters local and systemic proinflammatory cytokines in endometriosis patients.” Fertil Steril 105.4 (2016): 968–77.
  18. NICE guideline. Endometriosis: diagnosis and management. NICE guideline [NG73]. Published date: 06 September 2017.
  19. Petraglia, F. Endometriosis. From pathogenesis to clinical practice. International Digital Congress. Endometriosis 2021, 10–12 May 2021.
  20. Prescott, J., Farland, L.V., Tobias, D.K., et al. “A prospective cohort study of endometriosis and subsequent risk of infertility.” Hum Reprod 31.7 (2016): 1475–82.
  21. Redwine, D. The origine of endometriosis. International Digital Congress. Endometriosis 2021, 10–12 May 2021.
  22. Rolla, E. Endometriosis: advances and controversies in classification, pathogenesis, diagnosis, and treatment. F1000Res. 2019; 8 (F1000 Faculty Rev): 529.
  23. Shafrir, A.L., Farland, L.V., Shah, D.K., et al. “Risk for and consequences of endometriosis: A critical epidemiologic review.” Best Pract Res Clin Obstet Gynaecol 51 (2018): 1–15.
  24. Symons, L.K., Miller, J.E., Kay, V.R., et al. “The Immunopathophysiology of Endometriosis.” Trends Mol Med 24.9 (2018): 748–62.
  25. Wang, Y., Nicholes, K., Shih, I.M. “The Origin and Pathogenesis of Endometriosis.” Annu Rev Pathol 15 (2020): 71–95.
  26. Yajing, W., Yanchun, L., Haishan, L., et al. “Autonomic nervous system and inflammation interaction in endometriosis-associated pain.” J Neuroinflammation 17 (2020): 80.



How to Cite

Zhabitska, L., & Zhabitska, L. (2021). Endometriosis impact on the course of pregnancy and obstetric outcomes. REPRODUCTIVE ENDOCRINOLOGY, (60), 31–33. https://doi.org/10.18370/2309-4117.2021.60.31-33



Pregnancy and childbirth