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Abstract：
BACKGROUND: Recently, a history of endometriosis has been reported to be associated with several perinatal complications. However, it is unknown whether pre-pregnancy treatment for endometriosis reduces perinatal complications. In this study, we aimed to clarify the association between endometriosis and perinatal complications and investigate whether there is a significant difference in the incidence of placenta previa depending on the degree of surgical completion of endometriosis before pregnancy.
METHODS: This case-control study included 2781 deliveries at the Hirosaki University Hospital between January 2008 and December 2019. The deliveries were divided into a case group with a history of endometriosis (n = 133) and a control group without endometriosis (n = 2648). Perinatal outcomes and complications were compared between the case and control groups using a t-test and Fisher\'s exact test. Multiple logistic regression models were used to identify the risk factors for placenta previa. Additionally, we examined whether the degree of surgical completion of endometriosis before pregnancy was associated with the risk of placenta previa.
RESULTS: Patients with a history of endometriosis had a significantly higher risk of placenta previa (crude odds ratio, 2.66; 95% confidence interval, 1.37‒4.83). Multiple logistic regression analysis showed that a history of endometriosis was a significant risk factor for placenta previa (adjusted odds ratio, 2.30; 95% confidence interval, 1.22‒4.32). In addition, among patients with revised American Society for Reproductive Medicine stage III-IV endometriosis, the incidence of placenta previa was significantly lower in patients who underwent complete surgery (3/51 patients, 5.9%) than in those who did not (3/9 patients, 33.3%) (p = 0.038).
CONCLUSIONS: A history of endometriosis is an independent risk factor for placenta previa. Given the limitations of this study, further research is needed to determine the impact of endometriosis surgery on perinatal complications.
METHODS: This case-control study included 2781 deliveries at the Hirosaki University Hospital between January 2008 and December 2019. The deliveries were divided into a case group with a history of endometriosis (n = 133) and a control group without endometriosis (n = 2648). Perinatal outcomes and complications were compared between the case and control groups using a t-test and Fisher\'s exact test. Multiple logistic regression models were used to identify the risk factors for placenta previa. Additionally, we examined whether the degree of surgical completion of endometriosis before pregnancy was associated with the risk of placenta previa.
RESULTS: Patients with a history of endometriosis had a significantly higher risk of placenta previa (crude odds ratio, 2.66; 95% confidence interval, 1.37‒4.83). Multiple logistic regression analysis showed that a history of endometriosis was a significant risk factor for placenta previa (adjusted odds ratio, 2.30; 95% confidence interval, 1.22‒4.32). In addition, among patients with revised American Society for Reproductive Medicine stage III-IV endometriosis, the incidence of placenta previa was significantly lower in patients who underwent complete surgery (3/51 patients, 5.9%) than in those who did not (3/9 patients, 33.3%) (p = 0.038).
CONCLUSIONS: A history of endometriosis is an independent risk factor for placenta previa. Given the limitations of this study, further research is needed to determine the impact of endometriosis surgery on perinatal complications.
摘要：
背景：最近，据报道，子宫内膜异位症病史与几种围产期并发症有关。然而,目前尚不清楚子宫内膜异位症的孕前治疗是否能减少围产期并发症.在这项研究中,我们旨在阐明子宫内膜异位症与围产期并发症之间的关系,并调查妊娠前子宫内膜异位症手术完成程度不同,前置胎盘的发生率是否存在显著差异.
方法：这项病例对照研究包括2008年1月至2019年12月在Hirosaki大学医院分娩的2781例。将分娩分为有子宫内膜异位症病史的病例组（n=133）和无子宫内膜异位症的对照组（n=2648）。使用t检验和Fisher精确检验比较病例组和对照组的围产期结局和并发症。采用多因素logistic回归模型确定前置胎盘的危险因素。此外,我们检查了妊娠前子宫内膜异位症手术完成的程度是否与前置胎盘风险相关.
结果：有子宫内膜异位症病史的患者发生前置胎盘的风险明显较高（粗比值比，2.66；95%置信区间，1.37-4.83）。多因素logistic回归分析显示,子宫内膜异位症病史是前置胎盘的显著危险因素(调整后的比值比,2.30；95%置信区间，1.22-4.32)。此外,在修订的美国生殖医学学会III-IV期子宫内膜异位症患者中，在接受完整手术的患者中，前置胎盘的发生率显着降低（3/51患者，5.9％）比那些没有（3/9患者，33.3%)(p=0.038)。
结论：子宫内膜异位症病史是前置胎盘的独立危险因素。鉴于本研究的局限性，需要进一步的研究来确定子宫内膜异位症手术对围产期并发症的影响.
方法：这项病例对照研究包括2008年1月至2019年12月在Hirosaki大学医院分娩的2781例。将分娩分为有子宫内膜异位症病史的病例组（n=133）和无子宫内膜异位症的对照组（n=2648）。使用t检验和Fisher精确检验比较病例组和对照组的围产期结局和并发症。采用多因素logistic回归模型确定前置胎盘的危险因素。此外,我们检查了妊娠前子宫内膜异位症手术完成的程度是否与前置胎盘风险相关.
结果：有子宫内膜异位症病史的患者发生前置胎盘的风险明显较高（粗比值比，2.66；95%置信区间，1.37-4.83）。多因素logistic回归分析显示,子宫内膜异位症病史是前置胎盘的显著危险因素(调整后的比值比,2.30；95%置信区间，1.22-4.32)。此外,在修订的美国生殖医学学会III-IV期子宫内膜异位症患者中，在接受完整手术的患者中，前置胎盘的发生率显着降低（3/51患者，5.9％）比那些没有（3/9患者，33.3%)(p=0.038)。
结论：子宫内膜异位症病史是前置胎盘的独立危险因素。鉴于本研究的局限性，需要进一步的研究来确定子宫内膜异位症手术对围产期并发症的影响.
