Maternal and neonatal outcomes in women with colorectal endometriosis

ObjectiveTo evaluate delivery and neonatal outcomes in women with resected or in situ bowel endometriosis. DesignRetrospective cohort study. SettingFrance. Population and sampleAnalysis of 72 pregnancies from 67 women followed for colorectal endometriosis from 2001 to 2014 in six centres including two university expert centres for endometriosis. MethodsUnivariate analysis of maternal and neonatal outcomes. Main outcome measuresRoutes for delivery and rate of complications. ResultsThe colorectal surgery group comprised 41 women and the in situ colorectal group, 26 women. Overall, half of the women underwent caesarean section. A high incidence of postoperative complications (39%) was observed after caesarean section with no difference between the groups. Surgical difficulties at newborn extraction (22%) and postoperative complications (39%) occurred more often in women with anterior deep infiltrating endometriosis (respectively 63 versus 11%, P = 0.007 and 67% versus 26%, P = 0.046) independently of prior surgery for endometriosis. In the remaining half, vaginal delivery required an operative procedure in 28% of the women with a significant increase in postpartum complications compared with those who did not require a procedure (P = 0.001). Overall, the incidence of postpartum complications was lower after vaginal delivery (14%) than after caesarean section (39%) (P = 0.03). ConclusionPregnant women with colorectal endometriosis, irrespective of prior surgery, should be informed of the high risk of delivery by caesarean section. Vaginal delivery is preferrable in this setting because of the lower incidence of postpartum complications. Tweetable abstractDue to the incidence of postpartum complications whatever the route of delivery, women should receive level III maternal care. Tweetable abstract Due to the incidence of postpartum complications whatever the route of delivery, women should receive level III maternal care.