Delivery and pregnancy outcome in women with bowel resection for deep endometriosis: a retrospective cohort study

Endometriosis affects women in reproductive age and can involve bowel in 6–12 % of the patients. In case of bowel occlusion or deep pain, radical laparoscopic endometriosic surgery associated with bowel resection is recommended. The purpose of this study was to analyze the conception rate, the obstetric complications, and the pregnancy outcome. This is a retrospective study; we investigated 51 patients with deep endometriosis who underwent surgical treatment with bowel resection during the period between 2000 and 2007. Among the 30 patients who gave birth to at least one live child after surgery, we considered only the first pregnancy following bowel resection and we investigated the incidence of pregnancy disorders, the gestational age at delivery, the baby birth weight, and the complications related to the different ways of delivery. We compared the results with a control group of 93 patients with no previous abdominal surgery. The whole group of 51 patients tried to conceive after surgery, and 30 women had at least one pregnancy with the birth of an alive baby. Considering only the first pregnancies after surgery, 6 (20 %) experienced gestational hypertensive disorders, 3 (10 %) had placenta previa, 6 (20 %) had preterm birth (<37 weeks), and 1 patient (3.3 %) gestational diabetes. In this group, the average newborn weight was 3000 ± 545 g. Compared with the control group, women with previous bowel resection for deep endometriosis had a higher risk of hypertensive disorders (p < 0.05), placenta previa (p < 0.05), and lower newborn weight (p < 0.05), while the association with preterm birth and gestational diabetes was not statistically significant. These patients experience 12 vaginal deliveries (40 %) and 18 caesarean sections (60 %). Comparing with the caesarean rate in the control group (29.03 %), the incidence of caesarean section in the study population was substantially higher (p < 0.01) with 33.3 % of the sections performed because of previous bowel surgery. No differences in severe complication rates were observed between vaginal and caesarean deliveries (ns). Complete removal of endometriosis with bowel segmental resection seems to improve the pregnancy rate, but in this group, there is an increased incidence of hypertensive disorders, placenta previa, and lower newborn weight. Despite the small number of patients, we do not observe more complications in the vaginal group than in the caesarean group, so we hypothesize the previous radical surgery should not influence the way of delivery.