As pregnancy is an unavoidable factor in the life plan for most women, many patients diagnosed with endometriosis face additional concerns related to their fertility and the possibility of a successful pregnancy.

Endometriosis symptoms generally ease during pregnancy due to the increase in progesterone, a hormone that puts endometrial cells at rest. This improvement is limited to pregnancy and breastfeeding, with the disease then returning to its initial clinical state.

In a minority of pregnant women, the pain may persist or increase: on the one hand, if there are adhesions resulting from endometriosis (internal scars), the increased size of the uterus can pull them and cause discomfort; on the other hand, there is an increase in another hormone, oestrogen, which can stimulate the growth and activity of endometrial cells.

Acute complications may also occur but are much rarer. If there is previously an endometrioma, a collection of blood in the ovary, it may become enlarged, rupture, or become infected. There is an even greater likelihood of appendicitis, intestinal perforation, or spontaneous hemoperitoneum, that is, internal bleeding inside the abdomen.

Infertility is the first barrier for women with endometriosis in relation to pregnancy, affecting around 30% of patients. Conversely, about 70% become pregnant spontaneously.
Most pregnant women with endometriosis will be able to have a complication-free pregnancy. This fact does not invalidate the fact that there is an increased probability of complications that are important to be aware of.

In the first trimester, the risk of miscarriage and ectopic pregnancy (pregnancy located outside the uterus) increases.

Preterm premature rupture of membranes consists of the rupture of the water bag before the pregnancy has reached 37 weeks, and is a situation that is more serious the sooner it occurs. Placenta previa is considered when it is located on or very close to the cervix, creating the risk of detachment of this organ from the uterine wall and consequent haemorrhage, requiring a caesarean section. Foetuses with foetal growth restriction weigh less than predicted for their gestational age.

There is also an increased risk of gestational diabetes, gestational hypertension, and/or pre-eclampsia, a specific and potentially serious pregnancy-related disease that leads to increased blood pressure and a variable degree of multiorgan dysfunction.

During the peri-partum period, we may encounter the following adverse conditions: preterm birth (birth before 37 weeks of gestation), dystocia birth or caesarean section, postpartum haemorrhage, need for hospitalisation of the newborn in the Neonatal Intensive Care, and, very rarely, perinatal death.

We know that many pregnant women with endometriosis will have an uneventful pregnancy, but many will present additional challenges that it is important to know how to recognise and resolve, to guarantee a happy outcome for mother and baby. This requires a joint effort from the expectant mother, her family, and a multidisciplinary healthcare team with knowledge and experience in addressing this condition.

This text is written by Dr. Samanta Soares, Obstetrician Gynaecologist at HPA - Gambelas

For more information please contact Grupo HPA Saude on (+351) 282 420 400.