1
|
Krajec M, Lebar V, Kornhauser Cerar L, Lukanovic D, Meglic L. Spontaneous Haemoperitoneum in the Third Trimester of Pregnancy Due to Adenomyosis: A Case Report. Cureus 2024; 16:e63718. [PMID: 39099916 PMCID: PMC11294772 DOI: 10.7759/cureus.63718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 08/06/2024] Open
Abstract
Spontaneous haemoperitoneum in pregnancy (SHiP) is a rare condition that can seriously endanger the life of both the mother and child. It can occur at any time during pregnancy but is most common in the last trimester. The etiology of SHiP is unknown. Endometriosis is one of the main risk factors for spontaneous haemoperitoneum due to the rupture of the utero-ovarian vasculature or bleeding from endometrial foci in the abdomen, but so is adenomyosis. We present an infrequent clinical case of a patient with uterine adenomyosis rupture and bleeding from endometrial foci in the third trimester of pregnancy.
Collapse
Affiliation(s)
- Maja Krajec
- Department of Gynaecological Oncology, Institute of Oncology Ljubljana, Ljubljana, SVN
| | - Vojka Lebar
- Department of Gynaecological Oncology, Institute of Oncology Ljubljana, Ljubljana, SVN
| | - Lilijana Kornhauser Cerar
- Department of Perinatology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, SVN
| | - David Lukanovic
- Department of Gynaecology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, SVN
| | - Leon Meglic
- Department of Gynaecology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, SVN
| |
Collapse
|
2
|
Schreurs AMF, Overtoom EM, de Boer MA, van der Houwen LEE, Lier MCI, van den Akker T, Cornette J, Vogelvang TE, Beenakkers ICM, Rosman AN, Maas JWM, Heineman DJ, Finken MJJ, de Vries JJJ, Burger NB, Schaap TP, Bloemenkamp KWM, Mijatovic V. Spontaneous haemoperitoneum in pregnancy: Nationwide surveillance and Delphi audit system. BJOG 2023; 130:1620-1628. [PMID: 37280664 DOI: 10.1111/1471-0528.17556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/29/2023] [Accepted: 05/11/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the incidence, diagnostic management strategies and clinical outcomes of women with spontaneous haemoperitoneum in pregnancy (SHiP) and reassess the definition of SHiP. DESIGN A population-based cohort study using the Netherlands Obstetric Surveillance System (NethOSS). SETTING Nationwide, the Netherlands. POPULATION All pregnant women between April 2016 and April 2018. METHODS This is a case study of SHiP using the monthly registry reports of NethOSS. Complete anonymised case files were obtained. A newly introduced online Delphi audit system (DAS) was used to evaluate each case, to make recommendations on improving the management of SHiP and to propose a new definition of SHiP. MAIN OUTCOME MEASURES Incidence and outcomes, lessons learned about clinical management and the critical appraisal of the current definition of SHiP. RESULTS In total, 24 cases were reported. After a Delphi procedure, 14 cases were classified as SHiP. The nationwide incidence was 4.9 per 100 000 births. Endometriosis and conceiving after artificial reproductive techniques were identified as risk factors. No maternal and three perinatal deaths occurred. Based on the DAS, adequate imaging of free intra-abdominal fluid, and identifying and treating women with signs of hypovolemic shock could improve the early detection and management of SHiP. A revised definition of SHiP was proposed, excluding the need for surgical or radiological intervention. CONCLUSIONS SHiP is a rare and easily misdiagnosed condition that is associated with high perinatal mortality. To improve care, better awareness among healthcare workers is needed. The DAS is a sufficient tool to audit maternal morbidity and mortality.
Collapse
Affiliation(s)
- Anneke M F Schreurs
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Evelien M Overtoom
- Department of Obstetrics, Division Woman and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marjon A de Boer
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lisette E E van der Houwen
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Marit C I Lier
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
- Athena Institute, VU University, Amsterdam, the Netherlands
| | - Jerome Cornette
- Department of Obstetrics and Fetal Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Tatjana E Vogelvang
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, the Netherlands
| | - Ingrid C M Beenakkers
- Department of Anaesthesiology, Division Vital Functions, Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Jacques W M Maas
- Department of Obstetrics and Gynaecology and GROW - School for Oncology and Reproduction, Maastricht UMC+, Maastricht, the Netherlands
| | - David J Heineman
- Department of Surgery and Cardiothoracic Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Martijn J J Finken
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
- Department of Paediatric Endocrinology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jan J J de Vries
- Department of Radiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Nicole B Burger
- Department of Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Timme P Schaap
- Department of Obstetrics, Division Woman and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Division Woman and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Velja Mijatovic
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| |
Collapse
|
3
|
Spontaneous Hemoperitoneum in Pregnancy and Endometriosis: A New Challenge in a Known Disease. Obstet Gynecol Surv 2023; 78:165-170. [PMID: 36893336 DOI: 10.1097/ogx.0000000000001107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Importance Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare life-threatening event previously associated with endometriosis. Although pregnancy is thought to improve the symptoms of endometriosis, abrupt intraperitoneal bleeding can occur, jeopardizing both maternal and fetal outcomes. Objective The aim of this study was to review the published information regarding SHiP pathophysiology, presentation, diagnosis, and management in a flowchart approach. Evidence Acquisition A descriptive review of published articles in the English-language was carried out. Results SHiP most commonly presents in the second half of pregnancy with a combination of abdominal pain, hypovolemia, a decline in hemoglobin level, and fetal distress. Nonspecific gastrointestinal symptoms are not uncommon. Surgical management is suitable in most scenarios and avoids complications such as recurrent bleeding and infected hematoma. Maternal outcome has improved greatly, whereas perinatal mortality remained unchanged. In addition to physical strain, SHiP was reported to have a psychosocial sequela. Conclusions and Relevance A high index of suspicion is required when patients present with acute abdominal pain and signs of hypovolemia. Early use of sonography contributes to narrowing down the diagnosis. Health care providers should be familiar with the SHiP diagnosis because early identification is crucial when attempting to safeguard maternal and fetal outcomes. Maternal and fetal requirements are often contradictory, creating a greater challenge in decision-making and treatment. A multidisciplinary team approach should coordinate the treatment, whenever a SHiP diagnosis is suspected.
Collapse
|
4
|
Bazzurini L, Ornaghi S, Colciago E, Penati C, di Gennaro F, Passoni P, Buda A, Locatelli A, Landoni F, Vergani P. Endometriosis-related spontaneous hemoperitoneum in pregnancy: A case series. J Obstet Gynaecol Res 2023; 49:744-752. [PMID: 36366961 DOI: 10.1111/jog.15498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/03/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022]
Abstract
Endometriosis can be associated with adverse pregnancy outcomes. We report six cases of endometriosis-related spontaneous hemoperitoneum diagnosed in pregnant and postpartum women over 13 years. Spontaneous hemoperitoneum in pregnancy mainly occurred in the second half of gestation. All women presented with acute abdominal pain; four of them needed an emergent surgery, two were managed expectantly. The median estimated blood loss was 4250 ml, four women required massive transfusion. Three out of six women had a known history of endometriosis, all of them had histologically confirmed endometriosis after surgery. No maternal or perinatal deaths occurred. In one case, reticence to perform a computed tomography scan led to delayed diagnosis. Since delay can lead to lethal consequences, high levels of suspicion for spontaneous hemoperitoneum should be maintained in cases of severe abdominal pain, even with a woman's negative history of endometriosis. Improved knowledge and regular interdisciplinary meetings are pivotal to ameliorate outcomes.
Collapse
Affiliation(s)
- Luca Bazzurini
- Department of Obstetrics and Gynecology, Division of Gynecology, San Gerardo Hospital, Monza e Brianza, Italy
| | - Sara Ornaghi
- Department of Obstetrics and Gynecology, Division of Obstetrics, Foundation MBBM Onlus at San Gerardo Hospital, University of Milan-Bicocca, Department of Medicine and Surgery, Monza e Brianza, Italy
| | - Elisabetta Colciago
- University of Milan-Bicocca, Department of Medicine and Surgery, Monza e Brianza, Italy
| | - Cristina Penati
- Department of Obstetrics and Gynecology, Carate Brianza Hospital, Monza e Brianza, Italy
| | | | - Paolo Passoni
- Department of Obstetrics and Gynecology, Division of Gynecology, San Gerardo Hospital, Monza e Brianza, Italy
| | - Alessandro Buda
- Department of Obstetrics and Gynecology, Division of Gynecology, San Gerardo Hospital, Monza e Brianza, Italy
| | - Anna Locatelli
- University of Milan-Bicocca, Department of Medicine and Surgery, Monza e Brianza, Italy.,Department of Obstetrics and Gynecology, Carate Brianza Hospital, Monza e Brianza, Italy
| | - Fabio Landoni
- Department of Obstetrics and Gynecology, Division of Gynecology, San Gerardo Hospital, Monza e Brianza, Italy.,University of Milan-Bicocca, Department of Medicine and Surgery, Monza e Brianza, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, Division of Obstetrics, Foundation MBBM Onlus at San Gerardo Hospital, University of Milan-Bicocca, Department of Medicine and Surgery, Monza e Brianza, Italy
| |
Collapse
|
5
|
Nayak D, Thangavel A, Sagili H. Spontaneous Hemoperitoneum in Third Trimester of Pregnancy-an Enigma. J Obstet Gynaecol India 2022; 72:449-453. [PMID: 36458069 PMCID: PMC9568628 DOI: 10.1007/s13224-021-01522-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/23/2021] [Indexed: 11/24/2022] Open
Abstract
Spontaneous hemoperitoneum in pregnancy is a rare and challenging obstetric emergency. It can present as acute abdomen with features of hypovolemic shock and requires high index of suspicion for diagnosis as various obstetric and non-obstetric causes have similar presenting features. Here we present a case of primigravida at 33 weeks of gestation who presented with acute abdomen, signs of shock and a pathological trace on cardiotocogram. She underwent laparotomy and cesarean section in view of suspicion of abruption placentae. Intraoperatively there was hemoperitoneum of 600 ml with 750 g clots and a small venous bleeder on the posterior surface of the uterus which was secured with hemostatic sutures. Patient got discharged along with the baby on seventh postoperative day. Timely intervention is paramount in reducing maternal morbidity and mortality.
Collapse
Affiliation(s)
- Deepthi Nayak
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006 India
| | - Arthi Thangavel
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006 India
| | - Haritha Sagili
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006 India
| |
Collapse
|
6
|
Mazzocco MI, Donati S, Maraschini A, Corsi E, Colciago E, Guelfi F, Cetin I. Spontaneous hemoperitoneum in pregnancy: Italian prospective population-based cohort study. Acta Obstet Gynecol Scand 2022; 101:1220-1226. [PMID: 36047477 PMCID: PMC9812087 DOI: 10.1111/aogs.14431] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/17/2022] [Accepted: 07/16/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Spontaneous hemoperitoneum in pregnancy is defined as a sudden non-traumatic intraperitoneal bleeding in pregnancy and up to 42 days postpartum. In the present study we aim to estimate the incidence and investigate the risk factors, the management and the outcomes of spontaneous hemoperitoneum in pregnancy in order to improve its clinical identification and reduce avoidable maternal deaths. MATERIAL AND METHODS This is a prospective population-based cohort study, set in maternity units from nine Italian regions covering 75% of the national births. The study population comprises all women admitted for spontaneous intraperitoneal hemorrhage during pregnancy and up to 42 days postpartum between November 2017 and March 2020. Incident cases were reported by trained clinicians through electronic data collection forms. Descriptive statistics were performed. The main outcome measures included incidence rate of spontaneous hemoperitoneum in pregnancy, association with potential risk factors, clinical management and maternal and perinatal outcomes. RESULTS Twenty-nine cases met the adopted definition of spontaneous hemoperitoneum in pregnancy with an estimated incidence rate of 0.04 per 1000 births. An increased risk ratio (RR) of this condition was observed in pregnancies conceived by assisted reproductive technology (RR = 6.60, 95% CI 2.52-17.29), in the case of multiple pregnancies (RR = 6.57, 95% CI 1.99-21.69) and maternal age ≥35 years (RR 2.10, 95% CI 1.01-4.35). In 17/29 cases the bleeding site was intra-pelvic (23.5% in the posterior uterine wall and 35.2% in the left hemipelvis). Laparotomy represented the surgical treatment in 27 cases (93%), and most women underwent a cesarean delivery (92.6%). Median blood loss was 1900 mL, one hysterectomy was necessary, and two women died. Twenty-two preterm births were recorded. CONCLUSIONS Spontaneous hemoperitoneum in pregnancy is a rare, life-threatening condition associated with high perinatal morbidity and mortality. Maternal age ≥35 years, multiple pregnancies and assisted reproductive technology were associated to a higher risk of the condition. Two women of 29 died and 70% of births occurred preterm.
Collapse
Affiliation(s)
- Martina Ilaria Mazzocco
- Obstetrics and Gynecology, Hospital Vittore BuzziDepartment of Biomedical and Clinical Sciences, University of MilanMilanItaly
| | - Serena Donati
- National Center for Disease Prevention and Health PromotionIstituto Superiore di Sanità ‐ Italian National Institute of HealthRomeItaly
| | - Alice Maraschini
- Technical‐scientific statistical serviceItalian National Institute of HealthRomeItaly
| | - Edoardo Corsi
- National Center for Disease Prevention and Health PromotionIstituto Superiore di Sanità ‐ Italian National Institute of HealthRomeItaly,Department of Biomedicine and PreventionUniversity of Rome Tor VergataRomeItaly
| | | | - Fabiola Guelfi
- Obstetrics and Gynecology, Hospital Vittore BuzziDepartment of Biomedical and Clinical Sciences, University of MilanMilanItaly
| | - Irene Cetin
- Obstetrics and Gynecology, Hospital Vittore BuzziDepartment of Biomedical and Clinical Sciences, University of MilanMilanItaly
| |
Collapse
|
7
|
Gaia G, Afonina M, Marconi AM. Stage IV endometriosis: to treat or not to treat before in-vitro fertilization? Further considerations besides the pregnancy rate: a case of near-miss for spontaneous hemoperitoneum. Minerva Obstet Gynecol 2022; 74:314-317. [PMID: 35642716 DOI: 10.23736/s2724-606x.22.05038-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endometriosis represents a well-known cause of infertility. Recently, its association with spontaneous hemoperitoneum in pregnancy (SHIP) was reported. Its occurrence seems to be increased in patients with endometriosis who underwent IVF techniques. We present a case of near miss at 15 weeks of pregnancy associated with SHIP in a nulliparous patient of 39 years old with chronic endometriosis. Previously, she underwent several IVF cycles and controlled ovarian hyperstimulation plus embryo transfer (COH-ET). An explorative laparoscopy was performed, then converted in laparotomy. The bleeding endometriotic tissue was removed and an ureteral stent was placed. The patient lost a total of 4 liters of blood and fully recovered. Unfortunately, miscarriage occurred. The potential link between COH-ET, the number of cycles of ovarian stimulation and SHIP in severe endometriosis must take a part in the balanced decision between preventive surgery of direct hormonal stimulation.
Collapse
Affiliation(s)
- Giorgia Gaia
- Department of Obstetrics and Gynecology, San Paolo Hospital Medical School, University of Milan, Milan, Italy -
| | - Margarita Afonina
- Department of Obstetrics and Gynecology, San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - Anna M Marconi
- Department of Obstetrics and Gynecology, San Paolo Hospital Medical School, University of Milan, Milan, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| |
Collapse
|
8
|
Filippi F, Benaglia L, Alagna F, La Vecchia I, Biancardi R, Reschini M, Somigliana E, Vercellini P. Decidualization of endometriosis in a cohort of IVF-mediated pregnancies. Sci Rep 2022; 12:1524. [PMID: 35087168 PMCID: PMC8795262 DOI: 10.1038/s41598-022-05635-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 01/13/2022] [Indexed: 01/01/2023] Open
Abstract
Decidualization is the process of endometrial change in pregnancy, a phenomenon that can involve also ovarian endometriomas. However, the frequency of this event remains unknown. In addition, there is no evidence on the decidualization of deep invasive endometriosis (DIE). To shed more light on this issue, we prospectively recruited women with ovarian endometriomas or DIE who underwent IVF. They were subsequently excluded if they did not become pregnant or if they had a miscarriage. The evaluation was repeated in five time points during pregnancy and post-partum. The primary outcome was the rate of decidualized endometriomas at 11-13 weeks' gestation. Data from 45 endometriomas and 15 nodules were available for data analyses. At the 11-13 weeks' ultrasound, endometriomas' decidualization was observed in seven cases, corresponding to 16% (95% CI 8-29%). Subsequent assessments in pregnancy failed to identify any additional case. DIE also underwent significant changes during pregnancy. At the 11-13 weeks' ultrasound, lesions were increased in size and more vascularized. In conclusion, decidualization of ovarian endometriomas in IVF pregnancies is not rare. DIE may also undergo decidualization, but further evidence is needed for a robust and shared definition of this process.
Collapse
Affiliation(s)
- Francesca Filippi
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122, Milan, Italy
| | - Laura Benaglia
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122, Milan, Italy
| | - Federica Alagna
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122, Milan, Italy
| | - Irene La Vecchia
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122, Milan, Italy
| | - Rossella Biancardi
- Centro Scienze Natalità, Gynecol/Obstet Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Marco Reschini
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122, Milan, Italy
| | - Edgardo Somigliana
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122, Milan, Italy.
| | - Paolo Vercellini
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
9
|
Benagiano G, Guo S. Age-dependent phenotypes of ovarian endometriomas. Reprod Med Biol 2022; 21:e12438. [PMID: 35386381 PMCID: PMC8967305 DOI: 10.1002/rmb2.12438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose To analyze the characteristics of the ovarian endometrioma (OE) across the life span of a woman. In the past, the OE has traditionally been viewed as a single, monolithic disease. Today, there are emerging data indicating that OE phenotypes differ according to the age of the woman. Method A narrative review of original articles on OE indexed by PubMed. Results When appearing in infancy and early adolescence, OE may be the consequence of endometrial cells retrogradely shed with neonatal uterine bleeding. The post-menarcheal variant, manifesting itself during full adolescence, is singularly frequent in the presence of vaginal or uterine outflow obstructive anomalies. The typical and most frequent adult phenotype is characterized by increasing fibrosis and a tendency to progress; its mere presence exerts a detrimental effect on the surrounding healthy ovarian tissue. In postmenopause, an old lesion may be reactivated in the presence of exogenous or endogenous estrogens, or even be produced ex novo; rarely, it can spread to a variety of organs and structures and even degenerate causing malignancies. Conclusions Given the existence of these variants, it is important to agree on management guidelines that take into consideration these different phenotypes.
Collapse
Affiliation(s)
| | - Sun‐Wei Guo
- Shanghai Obstetrics and Gynecology HospitalFudan UniversityShanghaiChina
| |
Collapse
|
10
|
Huang LY, Chiang CT, Wu MH. Spontaneous hemoperitoneum in pregnancy: Timely intervention is crucial to outcome. Taiwan J Obstet Gynecol 2021; 60:958. [PMID: 34507688 DOI: 10.1016/j.tjog.2021.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Lan-Yin Huang
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Ting Chiang
- Department of Pathology, Chiayi Hospital, Ministry of Health and Welfare, Chiayi, Taiwan
| | - Meng-Hsing Wu
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|
11
|
O'Brien E, Feroz R, Jasani S. Idiopathic spontaneous haemoperitoneum at 4 weeks gestation. BMJ Case Rep 2021; 14:e244470. [PMID: 34511413 PMCID: PMC8438716 DOI: 10.1136/bcr-2021-244470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/03/2022] Open
Abstract
A 20-year-old nulliparous patient with acute-onset abdominal pain and imaging suggestive of haemoperitoneum was admitted for observation. Though, initially, haemodynamically stable, her clinical picture worsened throughout her hospitalisation and warranted two separate laparoscopies that revealed 1200 mL and 50 mL of haemoperitoneum, respectively, without an identifiable bleeding source. After serial β-human chorionic gonadotropin levels and ultrasound confirmation of a viable pregnancy 23 days later, the patient underwent a normal antenatal course and delivered a healthy infant at 37 weeks gestation. This unusual case highlights the need to consider spontaneous haemoperitoneum in pregnancy as a diagnosis, particularly in the setting of pregnancy of unknown location, even at an early stage of pregnancy.
Collapse
Affiliation(s)
- Emily O'Brien
- Obstetrics and Gynecology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Rehan Feroz
- Obstetrics and Gynecology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Sona Jasani
- Obstetrics and Gynecology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| |
Collapse
|
12
|
Schreurs A, Lier M, Koning D, Brals C, De Boer MA, Lambalk CB, De Wit M, Mijatovic V. Severe psychological impact and impaired quality of life after a spontaneous haemoperitoneum in pregnancy in women with endometriosis and their partners. Facts Views Vis Obgyn 2021; 13:159-168. [PMID: 34184845 PMCID: PMC8291980 DOI: 10.52054/fvvo.13.2.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Spontaneous Haemoperitoneum in Pregnancy (SHiP) is a rare, but life-threatening complication of pregnancy that occurs predominantly in the third trimester of pregnancy and is associated with adverse pregnancy outcomes. Recently the largest case series in literature was published describing 11 Dutch cases of SHiP in women with endometriosis. Purpose To investigate experiences, psychological impact, and quality of life after SHiP. Methods A mixed-methods study was performed in women with a history of SHiP and their partners, including all known cases in the Netherlands between 2007 to 2015. Semi-structured in-depth interviews were organized between 2016 and 2017 and analysed thematically with a framework approach. Participants were asked to complete questionnaires investigating the impact of the event (Impact of Event Scale) and Quality of Life (RAND-36). Results Out of a total of 11 known cases, 7 women agreed for be individually interviewed. From these, all women described a freeze response at the moment of SHiP, combined with either an anxious reaction or a survival mode mind-set. All women received psychological help after SHiP. Still, the feeling of not being heard by the medical staff was present in all women. Other themes such as postpartum period, bonding with their child, effect on daily life, reviving the event, and future pregnancies were also identified in the interviews. In regard to their partners, 3 were interviewed, hence no saturation was achieved. Finally, the questionnaires showed lower Quality of Life and an impact score of ≥ 8/10. Conclusion SHiP had a profound impact on women and their partners. Dedicated psychological help should be offered to all women after experiencing SHiP.
Collapse
|
13
|
Hagimoto M, Tanaka H, Osuga Y, Miura K, Saito S, Sato S, Sugawara J, Ikeda T. Nationwide survey (Japan) on spontaneous hemoperitoneum in pregnancy. J Obstet Gynaecol Res 2021; 47:2646-2652. [PMID: 33949042 DOI: 10.1111/jog.14819] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/06/2021] [Accepted: 04/25/2021] [Indexed: 01/14/2023]
Abstract
AIM The purpose of this study was to evaluate the current state and clinical characteristics of spontaneous hemoperitoneum in pregnancy (SHiP) in Japan by performing a comprehensive survey. METHODS We reviewed data on pregnant women who developed SHiP during 2013-2017 (for 5 years), and were admitted to any of the perinatal centers in Japan. The survey assessed maternal background and maternal and neonatal prognosis. We divided the cases into two groups, favorable and poor prognosis groups, and made comparisons between the two groups. RESULTS Of the 407 facilities in Japan, 267 (66%) facilities responded to our survey. Overall, 31 cases of SHiP were registered. Maternal death occurred in one case (3%) due to liver bleeding with an unknown cause. Of 23 cases with a SHiP onset during pregnancy, 12 (53%) had been misdiagnosed as placental abruption. The prognosis for the fetuses included miscarriage or stillbirth in three cases (10%) and asphyxia in 12 cases (42%). There was no significant correlation between the amount of intra-abdominal blood loss and neonatal prognosis based on umbilical artery pH. Incidences of preterm birth <32 gestational weeks (adjusted odds ratio, 35.75; 95% confidence interval, 3.46-368.82) were higher in the poor prognosis group than that in the favorable group. Endometriosis and artificial reproductive techniques were both associated with 19% of all cases of SHiP. CONCLUSION SHiP was associated with maternal death and poor fetal prognosis. Prematurity and persistent uterine contractions which might be misdiagnosed as placental abruption seem to contribute to poor fetal prognosis.
Collapse
Affiliation(s)
- Miki Hagimoto
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan
| | - Kiyonori Miura
- Department of Obstetrics and Gynecology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shigeru Saito
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Shoji Sato
- Department of Obstetrics and Gynecology, Oita Prefectural Hospital, Oita, Japan
| | - Junichi Sugawara
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| |
Collapse
|
14
|
Benaglia L, Mensi L, DI Gesaro L, Somigliana E. Safety of in-vitro fertilization in women with endometriosis. Minerva Obstet Gynecol 2021; 73:333-340. [PMID: 34008387 DOI: 10.23736/s2724-606x.21.04711-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Management of women with endometriosis in general is complex. It requires a multidisciplinary and tailored approach. The time of in-vitro fertilization (IVF) may be particularly complicated because women with the disease face peculiar additional risks. In particular, oocytes retrieval may be more difficult and women with endometriomas are exposed to a low but consistent risk of infection and ovarian abscess development. There are also concerns regarding progression of deep invasive peritoneal lesions and misdiagnosis of an occult early ovarian cancer. However, evidence on these latter points is more controversial. Taken together, this body evidence is generally reassuring and does not justify prophylactic surgery prior to IVF to shrink these risks. However, given the uncertainties, women with endometriosis must be informed in depth of these peculiar additional risks.
Collapse
Affiliation(s)
- Laura Benaglia
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy -
| | - Laura Mensi
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,University of Milan, Milan, Italy
| | - Luca DI Gesaro
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,University of Milan, Milan, Italy
| | - Edgardo Somigliana
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,University of Milan, Milan, Italy
| |
Collapse
|
15
|
Huang H, Takai Y, Mikami Y, Samejima K, Gomi Y, Narita T, Ichinose S, Itaya Y, Ono Y, Matsunaga S, Saitoh M, Seki H. Safety of transvaginal aspiration of cysts in pregnancies complicated with ovarian endometrioma. J Gynecol Obstet Hum Reprod 2021; 50:102146. [PMID: 33862263 DOI: 10.1016/j.jogoh.2021.102146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/28/2021] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Pregnancy complicated with ovarian endometrioma is a risk factor for preterm delivery and rupture or infection during pregnancy. This study aimed to clarify the effectiveness and safety of transvaginal aspiration during pregnancy for endometrioma diagnosed in the first trimester. DESIGN This retrospective observational study included 8 pregnant women with endometrioma who underwent transvaginal cyst aspiration at 12-14 weeks (aspiration group) between March 2011-March 2018 and 23 pregnant women with endometrioma who refused aspiration during the same period (observation group). METHODS Characteristics of patients were compared in both groups. Safety, feasability and complications of transvaginal cyst aspiration were reported. Complications and obstetrical outcomes were reported and compared in both groups. RESULTS The maximum cyst diameter was 8.9 ± 1.5 cm (mean ± standard deviation) in the aspiration group, which was significantly larger than that in the observation group (4.7 ± 0.2 cm). Four preterm deliveries (17.3%) occurred in the observation group and none in the aspiration group. The emergency cesarean section rate during delivery was 14.2% in the aspiration group and 43.7% in the observation group. CONCLUSIONS The aspiration group tended to have lower rate of preterm deliveries and emergency cesarean sections, suggesting that cyst aspiration could be an effective, minimally invasive, and safe management option for endometrioma during pregnancy.
Collapse
Affiliation(s)
- Haipeng Huang
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yasushi Takai
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yukiko Mikami
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Kouki Samejima
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yosuke Gomi
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Tatsuya Narita
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Shunichiro Ichinose
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yukiko Itaya
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yosihisa Ono
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Shigetaka Matsunaga
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Masahiro Saitoh
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Hiroyuki Seki
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| |
Collapse
|
16
|
Donnez O, Donnez J. Endometriosis and spontaneous hemoperitoneum in pregnancy: ab uno disce omnes… Is it always true? Fertil Steril 2021; 115:900. [PMID: 33750617 DOI: 10.1016/j.fertnstert.2021.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Olivier Donnez
- Institut du Sein et de Chirurgie Gynécologique d'Avignon, Polyclinique Urbain V (Elsan Group), Avignon, France
| | - Jacques Donnez
- Université Catholique de Louvain and Société de Recherche pour l'Infertilité (SRI), Brussels, Belgium
| |
Collapse
|
17
|
Benaglia L, Reschini M, La Vecchia I, Candotti G, Somigliana E, Vercellini P. Endometriosis and spontaneous hemoperitoneum in pregnancy: evaluation of the magnitude of the risk in women becoming pregnant via in vitro fertilization. Fertil Steril 2020; 115:1023-1028. [PMID: 33272632 DOI: 10.1016/j.fertnstert.2020.10.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To estimate the frequency of spontaneous hemoperitoneum in pregnancy (SHiP) in women with endometriosis achieving pregnancy with in vitro fertilization (IVF). DESIGN Retrospective case series. SETTING Referral academic assisted reproductive technology (ART) center. PATIENT(S) Three hundred and forty-eight women with a history of surgery for endometriosis and women with ovarian endometriomas or deep endometriotic nodules detected at basal transvaginal ultrasound performed before IVF cycle. INTERVENTION(S) Information obtained from patients' charts on basal characteristics, IVF cycle, and pregnancy outcomes, and binomial distribution model created to determine the 95% confidence interval (CI) of the proportion of SHiP. MAIN OUTCOME MEASURE(S) Rate of SHiP. RESULT(S) Overall, 362 pregnancies were included, among which 238 (66%) had a history of previous surgery for endometriosis and 231 (64%) had endometriosis detected at ultrasound (107 women, 30%, had both). Pregnancies were achieved after fresh and frozen cycles in 244 (67%) and 118 (33%) women, respectively. One case of SHiP was recorded, corresponding to a rate of 0.3%. CONCLUSION(S) In the general population of women with endometriosis undergoing IVF, SHiP is uncommon. Future studies should better identify the risk factors for SHiP to disentangle the subgroups of women at higher risk.
Collapse
Affiliation(s)
- Laura Benaglia
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Marco Reschini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Irene La Vecchia
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | | | - Edgardo Somigliana
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Paolo Vercellini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
18
|
Kumari J, Harkin R. Abdominal apoplexy during pregnancy. BMJ Case Rep 2020; 13:13/10/e235946. [PMID: 33127691 DOI: 10.1136/bcr-2020-235946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of idiopathic spontaneous intraperitoneal haemorrhage (ISIH) in a 31-year-old patient at 37 weeks gestation in her second pregnancy. The patient presented to the labour ward with abdominal pain and uterine contractions. The initial complain was of sudden onset, severe sharp pain in left iliac fossa. She started having uterine contractions within 30 min of her presentation. Examination confirmed early labour with a footling breech presentation. Urgent caesarean section was performed that confirmed peritoneal bleeding of unknown origin with safe delivery of the baby. Mother and baby were safely discharged on day 5. 'Abdominal apoplexy' (ISIH), is a rare obstetric emergency with increased risk of fetal and maternal morbidity and mortality. With various clinical presentations as a possibility, diagnosis is challenging. High index of suspicion with prompt management of suspected cases can be pivotal life saving measure for the fetus and mother.
Collapse
Affiliation(s)
- Jasmeet Kumari
- Obstetrics and Gynaecology, Our Lady of Lourdes, Drogheda, Ireland
| | - Rosemary Harkin
- Obstetrics and Gynaecology, Our Lady of Lourdes, Drogheda, Ireland
| |
Collapse
|
19
|
Spontaneous hemoperitoneum in pregnancy due to endometriosis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2020. [DOI: 10.1177/2284026520942432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: Hemoperitoneum in pregnancy requires urgent evaluation. While spontaneous intraperitoneal bleeding is rare, ectopic endometrial tissue is a frequent cause of this event. Case: A 38-year-old woman with a history of endometriosis presented at 26 weeks gestation with 1 week of vague abdominal pain. Vital signs were within normal limits, and physical exam was notable for left-sided abdominal tenderness. Imaging demonstrated simple free fluid in her pelvis, concern for a uterine fundal defect and an adjacent hematoma. Exploratory laparotomy revealed hemoperitoneum secondary to highly vascularized stage 4 endometriosis. After classical cesarean delivery, a supracervical hysterectomy with bilateral oophorectomy was performed due to ongoing global pelvic hemorrhage. Conclusion: Consider endometriosis as a cause of spontaneous hemoperitoneum in pregnancy. Obstetricians should be prepared for significant maternal morbidity when encountering such pathology.
Collapse
|
20
|
Abstract
Endometriosis constitutes the presence of ectopic endometrial glands and stroma outside the uterine endometrium, which is hormonally responsive and responds to pregnancy hormones as well. Decidualization is a physiologic process, where the normal endometrium readies itself for optimal accommodation of a pregnancy. A similar hormonal response can be seen with ectopic endometrium as well. As such, ovarian endometriomas and deep endometriosis implants can undergo decidualization. Overall, the progestational state of pregnancy favors an improvement in endometriosis, however, decidualization can lead to findings that can lead to increased size of endometriomas and deep infiltrative endometriosis implants, changes in imaging appearance and even complications, such as spontaneous hemoperitoneum in pregnancy. Awareness of this process can help prevent misdiagnosis of decidualized endometriomas as ovarian malignancy and recognize common imaging manifestations of hormonal effects of pregnancy on endometriosis.
Collapse
|
21
|
Zilberman A, Eisenberg V, Yoeli R, Soriano D, Sivan E, Golan G, Mashiach R. Uterine Artery Pseudoaneurysm in a Pregnant Patient with Retrocervical Endometriosis. J Minim Invasive Gynecol 2020; 27:1209-1213. [PMID: 32259651 DOI: 10.1016/j.jmig.2020.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/22/2020] [Accepted: 03/27/2020] [Indexed: 11/24/2022]
Abstract
A pseudoaneurysm of the uterine artery or its branches is usually a result of vascular trauma during invasive procedures such as a cesarean section, vaginal delivery, myomectomy, hysterotomy, or dilatation and curettage. A uterine artery pseudoaneurysm rupture is a rare, yet life-threatening event. Deep infiltrating endometriosis usually involves a decrease in symptoms and imaging findings throughout pregnancy, with the notable exception of the phenomenon of decidualization. We present the case of a pregnant woman with a recent diagnosis of endometriosis, who conceived spontaneously and presented with disabling pain at 13 weeks' gestation. She was diagnosed with a left, huge (and rapidly growing) retrocervical endometriosis nodule encompassing a uterine artery pseudoaneurysm. Selective transarterial embolization was performed at 22 weeks' gestation owing to enlargement of the pseudoaneurysm sac, and the pseudoaneurysm was obliterated successfully. The patient was followed intensively throughout the pregnancy and the baby was delivered at term by cesarean section. After delivery, the nodule returned to the pregestational size.
Collapse
Affiliation(s)
- Ayala Zilberman
- Departments of Obstetrics and Gynecology (Drs. Zilberman, Eisenberg, Yoeli, Soriano, Sivan, and Mashiach).
| | - Vered Eisenberg
- Departments of Obstetrics and Gynecology (Drs. Zilberman, Eisenberg, Yoeli, Soriano, Sivan, and Mashiach)
| | - Rakefet Yoeli
- Departments of Obstetrics and Gynecology (Drs. Zilberman, Eisenberg, Yoeli, Soriano, Sivan, and Mashiach)
| | - David Soriano
- Departments of Obstetrics and Gynecology (Drs. Zilberman, Eisenberg, Yoeli, Soriano, Sivan, and Mashiach)
| | - Eyal Sivan
- Departments of Obstetrics and Gynecology (Drs. Zilberman, Eisenberg, Yoeli, Soriano, Sivan, and Mashiach)
| | - Gil Golan
- Diagnostic and Interventional Imaging (Dr. Golan), Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Roy Mashiach
- Departments of Obstetrics and Gynecology (Drs. Zilberman, Eisenberg, Yoeli, Soriano, Sivan, and Mashiach)
| |
Collapse
|
22
|
de Almeida Asencio F, Ribeiro HA, Ayrosa Ribeiro P, Malzoni M, Adamyan L, Ussia A, Gomel V, Martin DC, Koninckx PR. Symptomatic endometriosis developing several years after menopause in the absence of increased circulating estrogen concentrations: a systematic review and seven case reports. ACTA ACUST UNITED AC 2019. [DOI: 10.1186/s10397-019-1056-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Abstract
Background
To review women with symptomatic and clinically progressive endometriosis after menopause in the absence of estrogen intake or excessive systemic endogenous production.
Design
Seven case reports and a systematic review of the literature from 1995 till February 2018.
Results
Only 7 case reports from the authors and 29 cases from the literature described women with either cystic ovarian or deep endometriosis. Severity, symptoms, and localization are highly variable. No case report describes symptomatic superficial typical lesions. In 22 of 36 women (61%), symptoms started more than 10 years after menopause.
Conclusions
Symptomatic and clinically progressive endometriosis after menopause in the absence of increased systemic estrogen concentrations or exogenous estrogen intake starts more than 10 years after menopause in the majority of women. This observation suggests that a genetic and/or epigenetic incident caused estrogen-independent progression, increased sensitivity to estrogens or increased local production of estrogens. This observation is important for understanding the pathophysiology of endometriosis, for the management of postmenopausal endometriosis, and for individualization of medical therapy of endometriosis since estrogen-independent endometriosis growth probably also occurs before menopause.
Collapse
|
23
|
Somigliana E, Viganò P, Benaglia L, Busnelli A, Paffoni A, Vercellini P. Ovarian stimulation and endometriosis progression or recurrence: a systematic review. Reprod Biomed Online 2019; 38:185-194. [DOI: 10.1016/j.rbmo.2018.11.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/27/2018] [Accepted: 11/12/2018] [Indexed: 12/21/2022]
|
24
|
Koninckx PR, Ussia A, Adamyan L, Wattiez A, Gomel V, Martin DC. Pathogenesis of endometriosis: the genetic/epigenetic theory. Fertil Steril 2018; 111:327-340. [PMID: 30527836 DOI: 10.1016/j.fertnstert.2018.10.013] [Citation(s) in RCA: 200] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To study the pathophysiology of endometriosis. DESIGN Overview of observations on endometriosis. SETTING Not applicable. PATIENT(S) None. INTERVENTIONS(S) None. MAIN OUTCOME MEASURE(S) The hypothesis is compatible with all observations. RESULT(S) Endometriosis, endometrium-like tissue outside the uterus, has a variable macroscopic appearance and a poorly understood natural history. It is a hereditary and heterogeneous disease with many biochemical changes in the lesions, which are clonal in origin. It is associated with pain, infertility, adenomyosis, and changes in the junctional zone, placentation, immunology, plasma, peritoneal fluid, and chronic inflammation of the peritoneal cavity. The Sampson hypothesis of implanted endometrial cells following retrograde menstruation, angiogenic spread, lymphogenic spread, or the metaplasia theory cannot explain all observations if metaplasia is defined as cells with reversible changes and an abnormal behavior/morphology due to the abnormal environment. We propose a polygenetic/polyepigenetic mechanism. The set of genetic and epigenetic incidents transmitted at birth could explain the hereditary aspects, the predisposition, and the endometriosis-associated changes in the endometrium, immunology, and placentation. To develop typical, cystic ovarian or deep endometriosis lesions, a variable series of additional transmissible genetic and epigenetic incidents are required to occur in a cell which may vary from endometrial to stem cells. Subtle lesions are viewed as endometrium in a different environment until additional incidents occur. Typical cystic ovarian or deep endometriosis lesions are heterogeneous and represent three different diseases. CONCLUSION(S) The genetic epigenetic theory is compatible with all observations on endometriosis. Implications for treatment and prevention are discussed.
Collapse
Affiliation(s)
- Philippe R Koninckx
- Obstetrics-Gynecology, KU Leuven, Bierbeek, Belgium; Gruppo Italo Belga, Rome, Italy; Latiffa Hospital, Dubai, United Arab Emirates; Università Cattolica, Roma, Italy.
| | - Anastasia Ussia
- Gruppo Italo Belga, Rome, Italy; Università Cattolica, Roma, Italy
| | - Leila Adamyan
- Department of Operative Gynecology, Federal State Budget Institution V. I. Kulakov Research Centre for Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, and Department of Reproductive Medicine and Surgery, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Arnaud Wattiez
- Latiffa Hospital, Dubai, United Arab Emirates; Department of Obstetrics and Gynecology, University of Strasbourg, Strasbourg, France
| | - Victor Gomel
- Department of Obstetrics and Gynecology, University of British Columbia and Women's Hospital, Vancouver, British Columbia, Canada
| | - Dan C Martin
- School of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, and Virginia Commonwealth University, Richmond, Virginia
| |
Collapse
|
25
|
Gao FM, Liu GL. Four Case Reports of Endometriosis-Related Hemoperitoneum in Pregnancy. Chin Med J (Engl) 2018; 131:502-504. [PMID: 29451162 PMCID: PMC5830842 DOI: 10.4103/0366-6999.225048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Fu-Mei Gao
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - Guo-Li Liu
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing 100044, China
| |
Collapse
|
26
|
Glavind MT, Møllgaard MV, Iversen ML, Arendt LH, Forman A. Obstetrical outcome in women with endometriosis including spontaneous hemoperitoneum and bowel perforation: a systematic review. Best Pract Res Clin Obstet Gynaecol 2018; 51:41-52. [DOI: 10.1016/j.bpobgyn.2018.01.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/23/2018] [Indexed: 12/29/2022]
|
27
|
Koninckx PR, Ussia A, Zupi E, Gomel V. Association of Endometriosis and Adenomyosis: Vast Literature but Scant Conclusive Data. J Minim Invasive Gynecol 2018; 25:745-748. [DOI: 10.1016/j.jmig.2018.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/17/2018] [Indexed: 12/21/2022]
|
28
|
Vassilopoulou L, Matalliotakis M, Zervou MI, Matalliotaki C, Spandidos DA, Matalliotakis I, Goulielmos GN. Endometriosis and in vitro fertilisation. Exp Ther Med 2018; 16:1043-1051. [PMID: 30116357 PMCID: PMC6090275 DOI: 10.3892/etm.2018.6307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 06/13/2018] [Indexed: 01/06/2023] Open
Abstract
The aim of the present review was to discuss a matter of concern in the clinical field of obstetrics/gynecology, namely the potency of in vitro fertilization (IVF) in the management of endometriosis-associated infertility. Endometriosis is a medical condition affecting one tenth of women in their fertile years, and accounts for up to 50% of infertile women. Thus, such high prevalence has established the necessity for investigating the effectiveness of available techniques in eradicating the disease and constraining infertility as well as the accompanying pain symptoms of endometriosis. The underlying mechanisms connecting endometriosis with low fecundity have been extensively studied, both in terms of genetic alterations and epigenetic events that contribute to the manifestation of an infertility phenotype in women with the disease. Several studies have dealt with the impact of IVF in pregnancy rates (PRs) on patients with endometriosis, particularly regarding women who wish to conceive. Results retrieved from studies and meta-analyses depict a diverse pattern of IVF success, underlining the involvement of individual parameters in the configuration of the final outcome. The ultimate decision on undergoing IVF treatment should be based on objective criteria and clinicians' experience, customized according to patients' individual needs.
Collapse
Affiliation(s)
- Loukia Vassilopoulou
- Laboratory of Forensic Sciences and Toxicology, Medical School, University of Crete, Heraklion 71409, Crete, Greece
| | - Michail Matalliotakis
- Department of Obstetrics and Gynecology, Venizeleio and Pananio General Hospital of Heraklion, Heraklion 71409, Crete, Greece
| | - Maria I Zervou
- Section of Molecular Pathology and Human Genetics, Department of Internal Medicine, School of Medicine, University of Crete, Heraklion 71003, Crete, Greece
| | - Charoula Matalliotaki
- Department of Obstetrics and Gynecology, Venizeleio and Pananio General Hospital of Heraklion, Heraklion 71409, Crete, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, Heraklion 71003, Crete, Greece
| | - Ioannis Matalliotakis
- Department of Obstetrics and Gynecology, Venizeleio and Pananio General Hospital of Heraklion, Heraklion 71409, Crete, Greece
| | - George N Goulielmos
- Section of Molecular Pathology and Human Genetics, Department of Internal Medicine, School of Medicine, University of Crete, Heraklion 71003, Crete, Greece
| |
Collapse
|
29
|
Vercellini P, Facchin F, Buggio L, Barbara G, Berlanda N, Frattaruolo MP, Somigliana E. Management of Endometriosis: Toward Value-Based, Cost-Effective, Affordable Care. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:726-749.e10. [DOI: 10.1016/j.jogc.2017.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/12/2017] [Indexed: 12/13/2022]
|
30
|
[Management by assisted reproductive technology in women with endometriosis: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018. [PMID: 29523480 DOI: 10.1016/j.gofs.2018.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Should the presence of endometriosis change the management of assisted reproductive technology? There is no difference in pregnancy rate after IVF between an agonist or antagonist protocol in patients with endometriosis, so the choice between one or the other of these protocols is free. But the review of the literature has shown an improvement in the chances of pregnancy in case of prolonged ovulation suppression before stimulation for IVF with a GnRH agonist analogue or with oral contraception, especially in cases of severe endometriosis. Endometriosis, regardless of the stage and type of lesions, would have no effect on the IVF results in terms of pregnancy rate and live birth rate, but with a lower number of oocytes collected, especially in cases of severe endometriosis. In a context of superficial endometriosis without pain and of infertility, surgical treatment of superficial endometriosis is not recommended just to increase the chances of pregnancy in IVF. Surgery may have a place in case of failure of IVF to improve the results of the ART. In case of recurrence of endometriosis, surgery is not better than IVF, a medico-surgical concertation is recommended. In addition, studies on ovulation stimulation for IVF do not show any aggravation of the symptoms associated with endometriosis lesions, or an acceleration of its progression, or an increase in the rate of recurrence of the disease.
Collapse
|
31
|
Leeners B, Damaso F, Ochsenbein-Kölble N, Farquhar C. The effect of pregnancy on endometriosis—facts or fiction? Hum Reprod Update 2018; 24:290-299. [DOI: 10.1093/humupd/dmy004] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 02/03/2018] [Indexed: 01/12/2023] Open
Affiliation(s)
- Brigitte Leeners
- Department of Reproductive Endocrinology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Fabia Damaso
- Department of Reproductive Endocrinology, University Hospital Zurich, 8091 Zurich, Switzerland
| | | | - Cindy Farquhar
- Department of Gynaecology and Obstetrics, University Hospital Auckland, Park Road, 1023 Auckland, New Zealand
| |
Collapse
|
32
|
Brosens I, Puttemans P, Benagiano G. Which cell defines endometriosis? Hum Reprod 2018; 33:357-360. [DOI: 10.1093/humrep/dey016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 01/12/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Ivo Brosens
- Faculty of Medicine, Herestraat 49, 3000 Leuven, Belgium
| | - Patrick Puttemans
- Leuven Institute for Fertility and Embryology, Tiensevest 168, 3000 Leuven, Belgium
| | - Giuseppe Benagiano
- Department of Gynaecology, Obstetrics and Urology, ‘Sapienza’ University, Viale del Policlinico 155, 00161 Rome, Italy
| |
Collapse
|
33
|
Spontaneous hemoperitoneum in pregnancy (SHiP) and endometriosis — A systematic review of the recent literature. Eur J Obstet Gynecol Reprod Biol 2017; 219:57-65. [DOI: 10.1016/j.ejogrb.2017.10.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/23/2017] [Accepted: 10/10/2017] [Indexed: 12/14/2022]
|
34
|
Lier MCI, Mijatovic V. Authors' reply re: Spontaneous haemoperitoneum in pregnancy and endometriosis: a case series. BJOG 2017; 125:392-393. [PMID: 29094454 DOI: 10.1111/1471-0528.14948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Marit C I Lier
- Department of Reproductive Medicine, VU University Medical Centre, Endometriosis Centre VUmc, Amsterdam, the Netherlands
| | - Velja Mijatovic
- Department of Reproductive Medicine, VU University Medical Centre, Endometriosis Centre VUmc, Amsterdam, the Netherlands
| | -
- Department of Reproductive Medicine, VU University Medical Centre, Endometriosis Centre VUmc, Amsterdam, the Netherlands
| |
Collapse
|
35
|
Leone Roberti Maggiore U, Ferrero S, Candiani M, Somigliana E, Viganò P, Vercellini P. Bladder Endometriosis: A Systematic Review of Pathogenesis, Diagnosis, Treatment, Impact on Fertility, and Risk of Malignant Transformation. Eur Urol 2016; 71:790-807. [PMID: 28040358 DOI: 10.1016/j.eururo.2016.12.015] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/15/2016] [Indexed: 02/03/2023]
Abstract
CONTEXT The bladder is the most common site affected in urinary tract endometriosis. There is controversy regarding the pathogenesis, clinical management (diagnosis and treatment), impact on fertility, and risk of malignant transformation of bladder endometriosis (BE). OBJECTIVE To systematically evaluate evidence regarding the pathogenesis, diagnosis, medical and surgical treatment, impact on female fertility, and risk of malignant transformation of BE. EVIDENCE ACQUISITION A systematic review of PubMed/Medline from inception until October 2016 was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement and was registered in the PROSPERO registry (www.crd.york.ac.uk/prospero; CRD42016039281). Eighty-seven articles were selected for inclusion in this analysis. EVIDENCE SYNTHESIS BE is defined as the presence of endometrial glands and stroma in the detrusor muscle. Ultrasonography is the first-line technique for assessment of BE owing to its accuracy, safety, and cost. Clinical management can be conservative, using hormonal therapies, or surgical. When conservative treatment is preferred, estrogen-progestogen combinations and progestogens should be chosen because of their favorable profile that allows long-term therapy. Surgery should guarantee complete removal of the bladder nodule to minimize recurrence, so transurethral surgery alone should be avoided in favor of segmental bladder resection. There is not a strong rationale for hypothesizing a detrimental impact of BE per se on fertility. Furthermore, current evidence does not support the removal of bladder endometriotic lesions because of the potential risk of malignant transformation since this phenomenon is exceedingly rare. CONCLUSIONS BE is a challenging condition, and the common coexistence of other types of endometriosis means that clinical management of BE should involve collaboration between gynecologists and urologists. PATIENT SUMMARY In this article we review available knowledge on bladder endometriosis. The review provides a useful tool to guide physicians in the management of this complex condition.
Collapse
Affiliation(s)
- Umberto Leone Roberti Maggiore
- Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.
| | - Massimo Candiani
- Department of Obstetrics and Gynecology, Vita Salute San Raffaele University School of Medicine, IRCCS, Ospedale San Raffaele, Milan, Italy
| | - Edgardo Somigliana
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano and Department of Obstet-Gynecol, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Viganò
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Vercellini
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano and Department of Obstet-Gynecol, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|