Delli Carpini G, Giannella L, Di Giuseppe J, Montanari M, Fichera M, Pizzagalli D, Meccariello ML, Palazzo P, Valenza C, Francucci A, Ciavattini A. Effect of the mode of delivery on the risk of endometriosis recurrence: a retrospective cohort study.
Fertil Steril 2022;
118:1080-1087. [PMID:
36243596 DOI:
10.1016/j.fertnstert.2022.08.849]
[Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE
To evaluate the risk of endometriosis recurrence according to the mode of delivery (cesarean section vs. vaginal birth) in patients who had become pregnant with a live birth after surgery for endometriosis.
DESIGN
A retrospective cohort study. A Cox proportional-hazards regression was performed to evaluate the risk factors for endometriosis recurrence at 36 months of follow-up after the last pregnancy.
SETTING
Academic hospital.
PATIENT(S)
Patients who have had ≥1 pregnancy with a live birth following conservative surgery for ovarian endometriosis performed from January 2009 to December 2016 at our institution.
INTERVENTION(S)
Patients who underwent ≥1 cesarean section after surgery for endometriosis.
MAIN OUTCOME MEASURES
The recurrence rate of endometriosis after live-birth pregnancies obtained after the first surgery for endometriosis.
RESULTS
Patients with a history of ≥1 cesarean section after surgery for endometriosis have a higher risk of endometriosis recurrence than the patients who have had a vaginal birth, with an adjusted hazard ratio of 2.25 (95% confidence interval, 1.27-3.96).
CONCLUSION
A cesarean section after surgery for endometriosis is associated with a twofold high risk of endometriosis recurrence with respect to vaginal birth. A different follow-up approach may be needed in those patients, and avoiding inappropriate indications for cesarean sections in pregnant patients with a history of surgery for endometriosis is necessary.
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