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Endometriosis : what is it and how should it be managed to reduce risks during pregnancy?

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    A recent study has highlighted that women with endometriosis are more likely to suffer complications during pregnancy and require additional care. This blog considers what endometriosis is and the additional precautions required to try to reduce the risks for pregnant women and their babies.

    By Ali Cloak

What is endometriosis?

Endometriosis is a condition in which tissue which is normally found in the uterus (endometrium) is found elsewhere in the body, for example the top of the vagina or the ovaries.

It is a long-term chronic condition which is estimated to affect around 2 million women in the United Kingdom, most of whom are diagnosed between the ages of 25-40. It is recognised as being difficult to diagnose given the varied presentation of symptoms.

The symptoms of the condition vary greatly and include heavy or painful menstrual periods and abdominal pain.  Some women experience no symptoms at all. It can also cause fertility problems if the endometriosis affects the ovaries or fallopian tubes.

There is no known cure for the condition but many women experience a benefit in symptoms by using painkillers and/or hormone medication. In some circumstances, surgical removal of the relevant tissue can be performed to improve symptoms or aid fertility.

How does endometriosis affect pregnancy?

It is reported that the condition can make it harder to conceive in the first place but many women with the condition do become pregnant. The condition does however increase the risk of a number of serious complications during the pregnancy itself, including ectopic pregnancy, haemorrhage, miscarriage and prematurity.

Whilst the majority of pregnancies in women with the condition proceed without difficulty there is a markedly higher rate of complications identified in those with endometriosis. A recent study of almost 15,000 Scottish women, carried out by Aberdeen Royal Infirmary, demonstrated that, for women with endometriosis, there is increased risk of miscarriage, premature birth and needing a caesarean section.

Implications

Prof Andrew Horne, Consultant Gynaecologist at the University of Edinburgh spoke of the implications of the survey findings:

These new findings suggest that we may need to warn women with endometriosis who become pregnant that they are at higher risk of both early and late complications of pregnancy, and may warrant increased antenatal monitoring

The details are due to be presented shortly at the European Society of Human Reproductive and Embryology. The findings are yet to be subject to peer review by journal publication. However, the researchers say that the findings should be taken into account when advising women with endometriosis about their family planning and their care needs during pregnancy.

I will be following developments in relation to this with interest, particularly whether this study does lead to heightened vigilance of women with this condition during pregnancy, and whether this in turn will reduce the risks to mother and baby as a result of this condition.

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