(552) More Complicated Perioperative Course of Cesarean Section in Patients with Endometriosis

Recent studies suggest an increased risk of pregnancy complications and a higher incidence of cesarean sections (CS) in individuals with endometriosis. However, information on CS-specific outcomes in this population remains scarce. This study aimed to assess CS outcomes in patients with endometriosis.

Study Design:

A case-control study was conducted at a tertiary care center between 2011 and 2023. The study group included all women with endometriosis who underwent a CS that were matched at a 1:2 ratio based on women's age, date of CS, type of CS (emergency or elective), previous CS and gestational age to control group comprised of those without endometriosis. Individuals with multiple gestations were excluded from the study. Pregnancy, delivery, and perinatal outcomes were evaluated.

Results:

We compared 108 CS deliveries in the study group to 216 in the control group. Patients with endometriosis were more likely to be nulliparous (65.7% vs. 47.2%, p< 0.01), conceived via IVF (53.7% vs. 17.1%, p< 0.01), and had more placenta previa (7.4% vs. 2.3%, p=0.03). They also had more surgical adhesions (40.7% vs. 6.9%, p< 0.01), greater blood loss (600 mL vs. 500 mL, p< 0.01), and a larger drop in hemoglobin (1.36 vs. 1.1 g/dL, p=0.05). The time to fetal extraction was nearly longer (7 vs. 5 minutes, p=0.06). Among the endometriosis group, 63.9% had a history of surgery.

Conclusion:

Patients with endometriosis are at higher risk of a complicated CS, with increased blood loss and longer extraction times, possibly due to adhesions and placenta previa.