Prevalence of deep and ovarian endometriosis in early pregnancy: ultrasound diagnostic study.
Adult
Endometriosis
/ diagnostic imaging
Female
Humans
Infertility, Female
/ complications
Odds Ratio
Ovarian Diseases
/ diagnostic imaging
Pregnancy
Pregnancy Complications
/ diagnostic imaging
Prevalence
Prospective Studies
Ultrasonography, Prenatal
Urogenital Abnormalities
/ diagnostic imaging
Uterus
/ abnormalities
decidualization
endometriosis
pregnancy
prevalence
ultrasonography
Journal
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
ISSN: 1469-0705
Titre abrégé: Ultrasound Obstet Gynecol
Pays: England
ID NLM: 9108340
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
revised:
12
07
2021
received:
10
05
2021
accepted:
17
08
2021
pubmed:
27
8
2021
medline:
12
2
2022
entrez:
26
8
2021
Statut:
ppublish
Résumé
To assess the prevalence and morphological appearance of deep endometriosis and ovarian endometrioma using pelvic ultrasound examination in women attending for an early pregnancy assessment. This was a prospective observational study set within a dedicated early pregnancy unit. The study included 1341 consecutive women who attended for an early pregnancy assessment for reassurance or because of suspected early pregnancy complications. All women underwent a transvaginal scan to assess the location and viability of their pregnancy. In addition, a detailed examination of pelvic organs was carried out to detect the presence of endometriosis and other gynecological abnormalities. Data analysis was performed using logistic regression and multivariable analysis. The prevalence of deep endometriosis and/or ovarian endometrioma in women attending our early pregnancy unit was 4.9% (95% CI, 3.8-6.2%). In 33/66 (50.0% (95% CI, 37.9-62.1%)) women with endometriosis, this was a new diagnosis that was made during their early pregnancy scan. On multivariable analysis, the presence of endometriosis was strongly associated with a history of subfertility (odds ratio (OR), 3.15 (95% CI, 1.63-6.07)) and presence of a congenital uterine anomaly (OR, 5.69 (95% CI, 2.17-14.9)) and uterine fibroids (OR, 2.37 (95% CI, 1.31-4.28)). Morphological changes typical of decidualization were seen in 11/33 (33.3% (95% CI, 17.2-49.4%)) women with ovarian endometrioma and 18/57 (31.6% (95% CI, 19.5-43.7%)) women with deep endometriotic nodules. Deep endometriosis and ovarian endometrioma were present in a significant proportion of women attending for early pregnancy assessment. The prevalence varied depending on a history of subfertility, and therefore is likely to differ significantly among populations, depending on their characteristics. Ultrasound is a useful tool for the detection of endometriosis in early pregnancy and the identification of women who may benefit from specialist antenatal care. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
107-113Informations de copyright
© 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Références
Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med 2020; 382: 1244-1256.
Kuznetsov L, Dworzynski K, Davies M, Overton C; Guideline Committee. Diagnosis and management of endometriosis: summary of NICE guidance. BMJ 2017; 358: j4227.
Rawson JM. Prevalence of endometriosis in asymptomatic women. J Reprod Med 1991; 36: 513-515.
Hager M, Wenzl R, Riesenhuber S, Marschalek J, Kuessel L, Mayrhofer D, Ristl R, Kurz C, Ott J. The Prevalence of Incidental Endometriosis in Women Undergoing Laparoscopic Ovarian Drilling for Clomiphene-Resistant Polycystic Ovary Syndrome: A Retrospective Cohort Study and Meta-Analysis. J Clin Med 2019; 8: 1210.
Abrao MS, Gonçalves MO, Dias JA Jr, Podgaec S, Chamie LP, Blasbalg R. Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis. Hum Reprod 2007; 12: 3092-3097.
Piketty M, Chopin N, Dousset B, Millischer-Bellaische AE, Roseau G, Leconte M, Borghese B, Chapron C. Preoperative work-up for patients with deeply infiltrating endometriosis: transvaginal ultrasonography must definitely be the first-line imaging examination. Hum Reprod 2009; 24: 602-607.
Guerriero S, Condous G, van den Bosch T, Valentin L, Leone FPG, Van Schoubroeck D, Exacoustos C, Installé AJF, Martins WP, Abrao MS, Hudelist G, Bazot M, Alcazar JL, Gonçalves MO, Pascual MA, Ajossa S, Savelli L, Dunham R, Reid S, Menakaya U, Bourne T, Ferrero S, Leon M, Bignardi T, Holland T, Jurkovic D, Benacerraf B, Osuga Y, Somigliana E, Timmerman D. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol 2016; 48: 318-332.
Holland TK, Yazbek J, Cutner A, Saridogan E, Hoo WL, Jurkovic D. Value of transvaginal ultrasound in assessing severity of pelvic endometriosis. Ultrasound Obstet Gynecol 2010; 36: 241-248.
Bean E, Chaggar P, Thanatsis N, Dooley W, Bottomley C, Jurkovic D. Intra- and interobserver reproducibility of pelvic ultrasound for the detection and measurement of endometriotic lesions. Hum Reprod Open 2020; 2020: hoaa001.
Naftalin J, Hoo W, Pateman K, Mavrelos D, Holland T, Jurkovic D. How common is adenomyosis? A prospective study of prevalence using transvaginal ultrasound in a gynaecology clinic. Hum Reprod 2012; 27: 3432-3439.
Leone Roberti Maggiore U, Ferrero S, Mangili G, Bergamini A, Inversetti A, Giorgione V, Viganò P, Candiani M. A systematic review on endometriosis during pregnancy: diagnosis, misdiagnosis, complications and outcomes. Hum Reprod Update 2016; 22: 70-103.
Saraswat L, Ayansina DT, Cooper KG, Bhattacharya S, Miligkos D, Horne AW, Bhattacharya S. Pregnancy outcomes in women with endometriosis: a national record linkage study. BJOG 2017; 124: 444-452.
Exacoustos C, Lauriola I, Lazzeri L, De Felice G, Zupi E. Complications during pregnancy and delivery in women with untreated rectovaginal deep infiltrating endometriosis. Fertil Steril 2016; 106: 1129-1135.
Buttram V, Gomel V, Siegler A, DeCherney A, Gibbons W, March C. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Müllerian anomalies and intrauterine adhesions. Fertil Steril 1988; 6: 944-955.
Anderson J. The myometrium. In Gynecologic Imaging, Anderson J (ed.). Churchill Livingstone: Philadelphia, PA, USA, 1999; 243.
Van Holsbeke C, Van Calster B, Guerriero S, Savelli L, Paladini D, Lissoni AA, Czekierdowski A, Fischerova D, Zhang J, Mestdagh G, Testa AC. Endometriomas: their ultrasound characteristics. Ultrasound Obstet Gynecol 2010; 35: 730-740.
Fruscella E, Testa AC, Ferrandina G, Manfredi R, Zannoni GF, Ludovisi M, Malaggese M, Scambia G. Sonographic features of decidualized ovarian endometriosis suspicious for malignancy. Ultrasound Obstet Gynecol 2004; 24: 578-580.
Bazot M, Malzy P, Cortez A, Roseau G, Amouyal P, Darai E. Accuracy of transvaginal sonography and rectal endoscopic sonography in the diagnosis of deep infiltrating endometriosis. Ultrasound Obstet Gynecol 2007; 30: 994-1001.
Bean E, Wong M, Amin T, Pateman K, Jurkovic D. Decidualisation of endometriotic lesions in pregnancy. OP31.06, ISUOG World Congress. Vienna, Austria, September 16-19, 2017.
De Blasis I. Ultrasound appearance of decidualised deep endometriosis during pregnancy. OP31.05, ISUOG World Congress. Vienna, Austria, September 16-19, 2017.
Piriyev E, Römer T. Coincidence of uterine malformations and endometriosis: a clinically relevant problem? Arch Gynecol Obstet 2020; 302: 1237-1241.
Nicolaus K, Bräuer D, Sczesny R, Lehmann T, Diebolder H, Runnebaum IB. Unexpected coexistent endometriosis in women with symptomatic uterine leiomyomas is independently associated with infertility, nulliparity and minor myoma size. Arch Gynecol Obstet 2019; 300: 103-108.
Bulun SE, Imir G, Utsunomiya H, Thung S, Gurates B, Tamura M, Lin Z. Aromatase in endometriosis and uterine leiomyomata. J Steroid Biochem Mol Biol 2005; 95: 57-62.
Miyakoshi K, Tanaka M, Gabionza D, Takamatsu K, Miyazaki T, Yuasa Y, Mukai M, Yoshimura Y. Decidualized ovarian endometriosis mimicking malignancy. AJR Am J Roentgenol 1998; 171: 1625-1626.
Barbieri M, Somigliana E, Oneda S, Ossola MW, Acaia B, Fedele L. Decidualized ovarian endometriosis in pregnancy: a challenging diagnostic entity. Hum Reprod 2009; 24: 1818-1824.
Mascilini F, Moruzzi C, Giansiracusa C, Guastafierro F, Savelli L, De Meis L, Epstein E, Timor-Tritsch IE, Mailath-Pokorny M, Ercoli A, Exacoustos C. Imaging in gynecological disease (10): clinical and ultrasound characteristics of decidualized endometriomas surgically removed during pregnancy. Ultrasound Obstet Gynecol 2014; 44: 354-360.
Chertin B, Prat O, Farkas A, Reinus C. Pregnancy-induced vesical decidualized endometriosis simulating a bladder tumor. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18: 111-112.
Horne AW, Daniels J, Hummelshoj L, Cox E, Cooper KG. Surgical removal of superficial peritoneal endometriosis for managing women with chronic pelvic pain: time for a rethink? BJOG 2019; 126: 1414-1416.