Complications during pregnancy and delivery in women with untreated rectovaginal deep infiltrating endometriosis

High complication rates during pregnancy and atdelivery were observed in patients with posterior deep infiltrating endometriosis diagnosed at transvaginal sonography and confirmed through laparoscopy and histology.

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Volume 106, Issue 5, Pages 1129-1135


Caterina Exacoustos, M.D., Ph.D., Ilaria Lariola, M.D., Lucia Lazzeri, M.D., Ph.D., Giovanna De Felice, M.D., Errico Zupi, M.D.



To study outcomes and complications during pregnancy and at delivery in women with a posterior deep infiltrating endometriosis (DIE) nodule persisting after surgery and diagnosed at transvaginal sonography (TVS) in comparison with a control group of women without endometriosis.


Multicenter observational and cohort study.


University hospital.


Women (n = 200) with a posterior DIE nodule equal or more than 2 cm centimeters in size who desired a pregnancy and a control group of women (n = 300) with no previous recorded diagnosis of endometriosis who delivered in our clinic during the same time period.


Patient data collected from medical charts and by phone interviews.

Main Outcome Measure(s)

Evaluation of complications during pregnancy and delivery.


Of the 101 women with a posterior DIE nodule, 52 become pregnant among whom 25 used assisted reproductive technology. Of these 52 pregnancies, 11 ended in an early abortion, and 41 delivered a baby; 13 (31.7%) had a premature delivery, 7 (17.8%) a placenta praevia, and 28 (68.2%) had a cesarean delivery. When compared with the control group, the women with endometriosis had a higher risk of pregnancy complicated by preterm birth, placenta previa, placental abruption, and hypertension. Cesarean delivery and complications during surgery (hysterectomy, hemoperitoneum, and bladder injuries) were statistically significantly more frequent in women with endometriosis than in controls.


Women with an incomplete removal of posterior DIE have a high complications rate during pregnancy and delivery.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility┬« is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.