Existe um risco maior para desfechos obstétricos desfavoráveis em mulheres com endometriose? Uma avaliação das evidências

Annicchino, Giuliana; Malvezzi, Helena; Piccinato, Carla de Azevedo; Podgaec, Sérgio

doi:10.1055/s-0040-1708885

Giuliana Annicchino Address for correspondence Giuliana Annicchino, MD, Hospital Israelita Albert Einstein, São Paulo, Brazil (e-mail: giuliana.annicchino@einstein.com).

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil

https://orcid.org/0000-0003-4258-6815

Helena Malvezzi

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil

https://orcid.org/0000-0002-5504-6116

Carla de Azevedo Piccinato

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil

https://orcid.org/0000-0002-2872-5957

Sérgio Podgaec

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil

https://orcid.org/0000-0002-9760-6003

Address for correspondence Giuliana Annicchino, MD, Hospital Israelita Albert Einstein, São Paulo, Brazil (e-mail: giuliana.annicchino@einstein.com).

Conflict to Interests

The authors have no conflict of interests to declare.

Contributors

All of the authors contributed to the conception and design of the present study, to the data collection, or to the analysis and interpretation of data, as well as to the writing of the article or to the critical review of the intellectual content and to the final approval of the version to be published.

Obstetric outcomes - higher risk in patients with endometriosis
Higher quality studies	POPULATION	ENDOMETRIOSIS DIAGNOSIS	MODE OF CONCEPTION	WAS FIV TAKEN AS A BIAS?	STAGE OF THE DISEASE TAKEN AS ACCOUNT?
Berlac et al, 2017¹⁶16 Berlac JF, Hartwell D, Skovlund CW, Langhoff-Roos J, Lidegaard Ø. Endometriosis increases the risk of obstetrical and neonatal complications. Acta Obstet Gynecol Scand. 2017;96(06): 751–760. Doi: 10.1111/aogs.13111 https://doi.org/10.1111/aogs.13111...	11,739 women with endometriosis diagnosis vs. 615,533 women without endometriosis diagnosis.	Clinical ICD-10	Natural and artificial	Yes	Yes
Glavind et al, 2017¹⁷17 Glavind MT, Forman A, Arendt LH, Nielsen K, Henriksen TB. Endometriosis and pregnancy complications: a Danish cohort study. Fertil Steril. 2017;107(01):160–166. Doi: 10.1016/j.fertnstert. 2016.09.020 https://doi.org/10.1016/j.fertnstert.201...	82,793 women, 1,719 cases with endometriosis diagnosis.	ICD 10 and/or laparoscopic	Natural and artificial	Yes	No
Mannini et al, 2016¹⁸18 Mannini L, Sorbi F, Noci I, Ghizzoni V, Perelli F, Di Tommaso M, et al. New adverse obstetrics outcomes associated with endometriosis: a retrospective cohort study. Arch Gynecol Obstet. 2017; 295(01):141–151. Doi: 10.1007/s00404-016-4222-7 https://doi.org/10.1007/s00404-016-4222-...	Cases n= 262. A) 40 with DIE B) 222 without DIE (B.1- 188 singleton pregnancy and/or spontaneous pregnancy / B.2- 74 multiple gestation and/or FIV) vs. Control n = 524 without endometriosis.	Surgical and anatomopathological	Natural and artificial	Yes	Yes
Saraswat et al, 2016¹⁹19 Saraswat L, Ayansina DT, Cooper KG, Bhattacharya S, Miligkos D, Horne AW, Battacharya S. Pregnancy outcomes in women with endometriosis: a national record linkage study. BJOG. 2017;124 (03):444–452. Doi: 10.1111/1471-0528.13920 https://doi.org/10.1111/1471-0528.13920...	Cases n = 5,375 women with endometriosis diagnosis vs. Control n = 8280 women without endometriosis.	Surgical	Not evaluated	No	No
Stephansson et al, 2009²⁰20 Stephansson O, Kieler H, Granath F, Falconer H. Endometriosis, assisted reproduction technology, and risk of adverse pregnancy outcome. Hum Reprod. 2009;24(09):2341–2347. Doi: 10.1093/ humrep/dep186 https://doi.org/10.1093/humrep/dep186...	Cases (n = 13,090 endometriosis diagnosis) vs. Control (n= 1,429,585)	Clinical ICD-8: 625.3; ICD-9: 617; and ICD-10: n80	Natural and artificial	No	No
Lower quality studies	POPULATION	ENDOMETRIOSIS DIAGNOSIS	MODE OF CONCEPTION	WAS FIV TAKEN AS A BIAS?	DEGREE OF THE DISEASE TAKEN AS ACCOUNT?
Turocy et al, 2017²¹21 Turocy J, Farland LV, Yanushpolsky E. Pregnancy outcomes in frozen embryo transfers in women with endometriosis: a retrospective cohort study. Fertil Steril. 2017;108(03):E198. Doi: 10.1016/j.fertnstert.2017.07.584 https://doi.org/10.1016/j.fertnstert.201...	Women with transferred embryos (n = 1,616), 160 in the n with diagnosis of endometriosis.	Surgical	Artificial	No	Yes
Santulli et al, 2016²²22 Santulli P, Marcellin L, Menard S, Thubert T, Khodhnood B, Gayet V, et al. Increased rate of spontaneous miscarriages in endometriosis- affected women. Hum Reprod. 2016;31(05):1014–1023. Doi: 10.1093/humrep/dew035 https://doi.org/10.1093/humrep/dew035...	Case n = 284, women diagnosed with endometriosis (A. superficial 52 / B. endometrioma / C. Deep infiltration) vs. Control n = 466, women without diagnosis of endometriosis.	Surgical and anatomopathological	Natural and artificial	Yes	Yes
Fujii et al, 2016²³23 Fujii T,Wada-Hiraike O, Nagamatsu T, HaradaM, Hirata T, Koga K, et al. Assisted reproductive technology pregnancy complications are significantly associated with endometriosis severity before conception: a retrospective cohort study. Reprod Biol Endocrinol. 2016;14(01):73. Doi: 10.1186/s12958-016-0209-2 https://doi.org/10.1186/s12958-016-0209-...	Case n= 92 women with endometriosis diagnosis vs. Control n= 512 women without endometriosis	Laparoscopic	Artificial	No	Yes
Jaques et al, 2016⁶6 Jaques AM, Amor DJ, Baker HW, Healy DL, Ukoumunne OC, Breheny S, et al. Adverse obstetric and perinatal outcomes in subfertilewomen conceiving without assisted reproductive technologies. Fertil Steril. 2010;94(07):2674–2679. Doi: 10.1016/j.fertnstert.2010.02.043 https://doi.org/10.1016/j.fertnstert.201...	2,316 pregnancies by assisted reproduction and 160 with diagnosis of endometriosis	Surgical or clinical by image + clinical exam	Artificial	No	Yes
Lin et al, 2015²⁴24 LinH, Leng JH, Liu JT, Lang JH. Obstetric outcomes inChinesewomen with endometriosis: a retrospective cohort study. Chin Med J (Engl). 2015;128(04):455–458. Doi: 10.4103/0366-6999.151077 https://doi.org/10.4103/0366-6999.151077...	249 cases (women with endometriosis) vs. 249 controls (women without endometriosis)	Surgical and anatomopathological	Natural	No	No
Conti et al, 2014²⁵25 Conti N, Cevenini G, Vannuccini S, et al. Women with endometriosis at first pregnancy have an increased risk of adverse obstetric outcome. J Matern Fetal Neonatal Med. 2015;28(15):1795–1798. Doi: 10.3109/14767058.2014.968843 https://doi.org/10.3109/14767058.2014.96...	Population 2,239 women. Singleton pregnancy 1,331 control vs. 219 cases diagnosed with endometriosis. Multiparas: 592 control vs. 97 with diagnosis of endometriosis.	Surgical and anatomopathological	Natural and artificial	Yes	Yes
Aris, 2014²⁶26 Aris A. A 12-year cohort study on adverse pregnancy outcomes in Eastern Townships of Canada: impact of endometriosis. Gynecol Endocrinol. 2014;30(01):34–37. Doi: 10.3109/09513590.2013. 848425 https://doi.org/10.3109/09513590.2013.84...	Cases n = 784 women with endometriosis vs. Control n = 30,284 women without endometriosis.	Surgical	Natural and artificial	No	No
Mekaru et al, 2013²⁷27 Mekaru K, Masamoto H, Sugiyama H, Asato K, Heshiki C, Kinjyo T, Aoki Y. Endometriosis and pregnancy outcome: are pregnancies complicated by endometriosis a high-risk group? Eur J Obstet Gynecol Reprod Biol. 2014;172:36–39. Doi: 10.1016/j.ejogrb.2013. 10.024 https://doi.org/10.1016/j.ejogrb.2013.10...	108 pregnant women who had previously undergone laparoscopy to investigate infertility. 49 cases diagnosed with endometriosis vs. 59 controls.	Laparoscopic	Natural	No	Yes
Vercellini et al, 2012²⁸28 Vercellini P, Parazzini F, Pietropaolo G, Cipriani S, Frattaruolo MP, Fedele L. Pregnancyoutcome inwomenwithperitoneal, ovarian and rectovaginal endometriosis: a retrospective cohort study. BJOG. 2012;119(12):1538–1543. Doi: 10.1111/j.1471-0528.2012.03466.x https://doi.org/10.1111/j.1471-0528.2012...	419 cases (150 rectovaginal, 69 ovarian and peritoneal, 100 ovarian, 100 peritoneal)	Clinical by image	Natural	No	Yes
Hadfield et al, 2009²⁹29 Hadfield RM, Lain SJ, Raynes-Greenow CH, Morris JM, Roberts CL. Is there an association between endometriosis and the risk of preeclampsia? A population based study. Hum Reprod. 2009;24(09): 2348–2352. Doi: 10.1093/humrep/dep123 https://doi.org/10.1093/humrep/dep123...	Cases (n= 3,239 with endometriosis diagnosis) vs. Control (n = 205,640)	Clinical ICD-10	Natural and artificial	Yes	Yes
Brosens et al, 2007³⁰30 Brosens IA, De Sutter P, Hamerlynck T, Imeraj L, Yao Z, Cloke B, et al. Endometriosis is associated with a decreased risk of pre-eclampsia. Hum Reprod. 2007;22(06):1725–1729. Doi: 10.1093/humrep/ dem072 https://doi.org/10.1093/humrep/dem072...	Cases (n = 245 with diagnosis of infertility associated with endometriosis) vs. Control (n = 274 infertility associated with male factors)	Laparoscopic	Artificial	No	No
Hjordt Hansen et al, 2007³¹31 Hjordt Hansen MV, Dalsgaard T, Hartwell D, Skovlund CW, Lidegaard O. Reproductive prognosis in endometriosis. A national cohort study. Acta Obstet Gynecol Scand. 2014;93(05):483–489. Doi: 10.1111/aogs.12373 https://doi.org/10.1111/aogs.12373...	Cases n= 24,667 women with endometriosis diagnosis vs. Control n= 98,668 women without endometriosis.	Clinical - ICD10 80-80.9	Natural or artificial	No	Yes
Matorras et al, 1998³²32 Matorras R, Rodríguez F, Gutierrez de Terán G, Pijoan JI, Ramón O, Rodríguez-Escudero FJ. Endometriosis and spontaneous abortion rate: a cohort study in infertilewomen. Eur J Obstet Gynecol Reprod Biol. 1998;77(01):101–105. Doi: 10.1016/s0301-2115(97)00181-4 https://doi.org/10.1016/s0301-2115(97)00...	Cases n = 174 infertile women diagnosed with endometriosis. Control n = 174 infertile women without endometriosis.	Laparoscopic	Natural or artificial	Yes	Yes

Obstetric outcomes - higher risk in patients with endometriosis
Higher quality Studies	Abortion	Ectopic gestation	Congenital malformation	Fetal loss	Stillborn	Neonatal death
Berlac et al, 2017¹⁶16 Berlac JF, Hartwell D, Skovlund CW, Langhoff-Roos J, Lidegaard Ø. Endometriosis increases the risk of obstetrical and neonatal complications. Acta Obstet Gynecol Scand. 2017;96(06): 751–760. Doi: 10.1111/aogs.13111 https://doi.org/10.1111/aogs.13111...			OR 1.3; 95%CI 1.3--1.4			OR 1.8, 95%CI 1.4-2.1
Glavind et al, 2017¹⁷17 Glavind MT, Forman A, Arendt LH, Nielsen K, Henriksen TB. Endometriosis and pregnancy complications: a Danish cohort study. Fertil Steril. 2017;107(01):160–166. Doi: 10.1016/j.fertnstert. 2016.09.020 https://doi.org/10.1016/j.fertnstert.201...
Saraswat et al, 2017¹⁹19 Saraswat L, Ayansina DT, Cooper KG, Bhattacharya S, Miligkos D, Horne AW, Battacharya S. Pregnancy outcomes in women with endometriosis: a national record linkage study. BJOG. 2017;124 (03):444–452. Doi: 10.1111/1471-0528.13920 https://doi.org/10.1111/1471-0528.13920...	OR 1.76; 95%CI 1.44--2.15	OR 2,70; 95%CI 1.09--6.72				NR
Mannini et al, 2016¹⁸18 Mannini L, Sorbi F, Noci I, Ghizzoni V, Perelli F, Di Tommaso M, et al. New adverse obstetrics outcomes associated with endometriosis: a retrospective cohort study. Arch Gynecol Obstet. 2017; 295(01):141–151. Doi: 10.1007/s00404-016-4222-7 https://doi.org/10.1007/s00404-016-4222-...
Stephansson et al, 2009²⁰20 Stephansson O, Kieler H, Granath F, Falconer H. Endometriosis, assisted reproduction technology, and risk of adverse pregnancy outcome. Hum Reprod. 2009;24(09):2341–2347. Doi: 10.1093/ humrep/dep186 https://doi.org/10.1093/humrep/dep186...
Lower quality Studies	Abortion	Ectopic gestation	Congenital malformation	Fetal loss	Stillborn	Neonatal death
Turocy et al, 2017²¹21 Turocy J, Farland LV, Yanushpolsky E. Pregnancy outcomes in frozen embryo transfers in women with endometriosis: a retrospective cohort study. Fertil Steril. 2017;108(03):E198. Doi: 10.1016/j.fertnstert.2017.07.584 https://doi.org/10.1016/j.fertnstert.201...	OR 0.57; 95%CI 0.28-1.15	OR 1.52, 95%CI 0.19-11.93
Santulli et al, 2016²²22 Santulli P, Marcellin L, Menard S, Thubert T, Khodhnood B, Gayet V, et al. Increased rate of spontaneous miscarriages in endometriosis- affected women. Hum Reprod. 2016;31(05):1014–1023. Doi: 10.1093/humrep/dew035 https://doi.org/10.1093/humrep/dew035...	OR 1.70, 95%CI 1.34-2.26
Fujii et al, 2016²³23 Fujii T,Wada-Hiraike O, Nagamatsu T, HaradaM, Hirata T, Koga K, et al. Assisted reproductive technology pregnancy complications are significantly associated with endometriosis severity before conception: a retrospective cohort study. Reprod Biol Endocrinol. 2016;14(01):73. Doi: 10.1186/s12958-016-0209-2 https://doi.org/10.1186/s12958-016-0209-...
Jaques et al, 2016⁶6 Jaques AM, Amor DJ, Baker HW, Healy DL, Ukoumunne OC, Breheny S, et al. Adverse obstetric and perinatal outcomes in subfertilewomen conceiving without assisted reproductive technologies. Fertil Steril. 2010;94(07):2674–2679. Doi: 10.1016/j.fertnstert.2010.02.043 https://doi.org/10.1016/j.fertnstert.201...
Lin et al, 2015²⁴24 LinH, Leng JH, Liu JT, Lang JH. Obstetric outcomes inChinesewomen with endometriosis: a retrospective cohort study. Chin Med J (Engl). 2015;128(04):455–458. Doi: 10.4103/0366-6999.151077 https://doi.org/10.4103/0366-6999.151077...
Conti et al, 2014²⁵25 Conti N, Cevenini G, Vannuccini S, et al. Women with endometriosis at first pregnancy have an increased risk of adverse obstetric outcome. J Matern Fetal Neonatal Med. 2015;28(15):1795–1798. Doi: 10.3109/14767058.2014.968843 https://doi.org/10.3109/14767058.2014.96...
Aris. 2014²⁶26 Aris A. A 12-year cohort study on adverse pregnancy outcomes in Eastern Townships of Canada: impact of endometriosis. Gynecol Endocrinol. 2014;30(01):34–37. Doi: 10.3109/09513590.2013. 848425 https://doi.org/10.3109/09513590.2013.84...	OR 1.89; 95%CI 1,23-2,93			OR 2.03; 95%CI 1,42-2,90	OR 2.29; 95%CI 1.24-5.22
Mekaru et al, 2013²⁷27 Mekaru K, Masamoto H, Sugiyama H, Asato K, Heshiki C, Kinjyo T, Aoki Y. Endometriosis and pregnancy outcome: are pregnancies complicated by endometriosis a high-risk group? Eur J Obstet Gynecol Reprod Biol. 2014;172:36–39. Doi: 10.1016/j.ejogrb.2013. 10.024 https://doi.org/10.1016/j.ejogrb.2013.10...	NR
Vercellini et al, 2012²⁸28 Vercellini P, Parazzini F, Pietropaolo G, Cipriani S, Frattaruolo MP, Fedele L. Pregnancyoutcome inwomenwithperitoneal, ovarian and rectovaginal endometriosis: a retrospective cohort study. BJOG. 2012;119(12):1538–1543. Doi: 10.1111/j.1471-0528.2012.03466.x https://doi.org/10.1111/j.1471-0528.2012...
Hadfield et al, 2009²⁹29 Hadfield RM, Lain SJ, Raynes-Greenow CH, Morris JM, Roberts CL. Is there an association between endometriosis and the risk of preeclampsia? A population based study. Hum Reprod. 2009;24(09): 2348–2352. Doi: 10.1093/humrep/dep123 https://doi.org/10.1093/humrep/dep123...
Bronsens et al, 2007³⁰30 Brosens IA, De Sutter P, Hamerlynck T, Imeraj L, Yao Z, Cloke B, et al. Endometriosis is associated with a decreased risk of pre-eclampsia. Hum Reprod. 2007;22(06):1725–1729. Doi: 10.1093/humrep/ dem072 https://doi.org/10.1093/humrep/dem072...
Hjordt Hansen et al, 2007³¹31 Hjordt Hansen MV, Dalsgaard T, Hartwell D, Skovlund CW, Lidegaard O. Reproductive prognosis in endometriosis. A national cohort study. Acta Obstet Gynecol Scand. 2014;93(05):483–489. Doi: 10.1111/aogs.12373 https://doi.org/10.1111/aogs.12373...	OR 1.2; 95% CI 1.2-1.3	OR 1.9, 95%CI 1.8--2.1
Matorras et al, 1998³²32 Matorras R, Rodríguez F, Gutierrez de Terán G, Pijoan JI, Ramón O, Rodríguez-Escudero FJ. Endometriosis and spontaneous abortion rate: a cohort study in infertilewomen. Eur J Obstet Gynecol Reprod Biol. 1998;77(01):101–105. Doi: 10.1016/s0301-2115(97)00181-4 https://doi.org/10.1016/s0301-2115(97)00...	NR

Higher quality studies	Pre-eclampsia	Gestational diabetes	Cholestasis	Premature placental abruption	Premature rupture of membranes	Preterm labor
Berlac et al, 2017¹⁶16 Berlac JF, Hartwell D, Skovlund CW, Langhoff-Roos J, Lidegaard Ø. Endometriosis increases the risk of obstetrical and neonatal complications. Acta Obstet Gynecol Scand. 2017;96(06): 751–760. Doi: 10.1111/aogs.13111 https://doi.org/10.1111/aogs.13111...	OR 1.7; 95% CI 1.5-2.0			OR 2.0; 95% CI 1.7-2.3	OR 1.7; 95% CI 1.5-1.8
Glavind et al, 2017¹⁷17 Glavind MT, Forman A, Arendt LH, Nielsen K, Henriksen TB. Endometriosis and pregnancy complications: a Danish cohort study. Fertil Steril. 2017;107(01):160–166. Doi: 10.1016/j.fertnstert. 2016.09.020 https://doi.org/10.1016/j.fertnstert.201...	OR 1.37; 95%CI 1.06-1.77
Saraswat et al, 2017¹⁹19 Saraswat L, Ayansina DT, Cooper KG, Bhattacharya S, Miligkos D, Horne AW, Battacharya S. Pregnancy outcomes in women with endometriosis: a national record linkage study. BJOG. 2017;124 (03):444–452. Doi: 10.1111/1471-0528.13920 https://doi.org/10.1111/1471-0528.13920...	NR			NR
Mannini et al, 2016¹⁸18 Mannini L, Sorbi F, Noci I, Ghizzoni V, Perelli F, Di Tommaso M, et al. New adverse obstetrics outcomes associated with endometriosis: a retrospective cohort study. Arch Gynecol Obstet. 2017; 295(01):141–151. Doi: 10.1007/s00404-016-4222-7 https://doi.org/10.1007/s00404-016-4222-...	NR	NR	OR 0.21; 95%CI 0.08-0.54			OR 0.32; 95%CI 0.20-0.52
Stephansson et al, 2009²⁰20 Stephansson O, Kieler H, Granath F, Falconer H. Endometriosis, assisted reproduction technology, and risk of adverse pregnancy outcome. Hum Reprod. 2009;24(09):2341–2347. Doi: 10.1093/ humrep/dep186 https://doi.org/10.1093/humrep/dep186...
Lower quality studies	Pre-eclampsia	Gestational diabetes	Cholestasis	Premature placental abruption	Premature rupture of membranes	Preterm labor
Turocy et al, 2017²¹21 Turocy J, Farland LV, Yanushpolsky E. Pregnancy outcomes in frozen embryo transfers in women with endometriosis: a retrospective cohort study. Fertil Steril. 2017;108(03):E198. Doi: 10.1016/j.fertnstert.2017.07.584 https://doi.org/10.1016/j.fertnstert.201...
Santulli et al, 2016²²22 Santulli P, Marcellin L, Menard S, Thubert T, Khodhnood B, Gayet V, et al. Increased rate of spontaneous miscarriages in endometriosis- affected women. Hum Reprod. 2016;31(05):1014–1023. Doi: 10.1093/humrep/dew035 https://doi.org/10.1093/humrep/dew035...
Fujii et al, 2016²³23 Fujii T,Wada-Hiraike O, Nagamatsu T, HaradaM, Hirata T, Koga K, et al. Assisted reproductive technology pregnancy complications are significantly associated with endometriosis severity before conception: a retrospective cohort study. Reprod Biol Endocrinol. 2016;14(01):73. Doi: 10.1186/s12958-016-0209-2 https://doi.org/10.1186/s12958-016-0209-...
Jaques et al, 2016⁶6 Jaques AM, Amor DJ, Baker HW, Healy DL, Ukoumunne OC, Breheny S, et al. Adverse obstetric and perinatal outcomes in subfertilewomen conceiving without assisted reproductive technologies. Fertil Steril. 2010;94(07):2674–2679. Doi: 10.1016/j.fertnstert.2010.02.043 https://doi.org/10.1016/j.fertnstert.201...	OR 8.53; 95%CI 1.05-69.40
Lin et al, 2015²⁴24 LinH, Leng JH, Liu JT, Lang JH. Obstetric outcomes inChinesewomen with endometriosis: a retrospective cohort study. Chin Med J (Engl). 2015;128(04):455–458. Doi: 10.4103/0366-6999.151077 https://doi.org/10.4103/0366-6999.151077...	NR			NR
Conti et al, 2014²⁵25 Conti N, Cevenini G, Vannuccini S, et al. Women with endometriosis at first pregnancy have an increased risk of adverse obstetric outcome. J Matern Fetal Neonatal Med. 2015;28(15):1795–1798. Doi: 10.3109/14767058.2014.968843 https://doi.org/10.3109/14767058.2014.96...	NR	OR 2.13; 95%CI 1.32-3.44			OR 2.93; 95%CI 1.24-6.87
Aris. 2014²⁶26 Aris A. A 12-year cohort study on adverse pregnancy outcomes in Eastern Townships of Canada: impact of endometriosis. Gynecol Endocrinol. 2014;30(01):34–37. Doi: 10.3109/09513590.2013. 848425 https://doi.org/10.3109/09513590.2013.84...	NR	NR
Mekaru et al, 2013²⁷27 Mekaru K, Masamoto H, Sugiyama H, Asato K, Heshiki C, Kinjyo T, Aoki Y. Endometriosis and pregnancy outcome: are pregnancies complicated by endometriosis a high-risk group? Eur J Obstet Gynecol Reprod Biol. 2014;172:36–39. Doi: 10.1016/j.ejogrb.2013. 10.024 https://doi.org/10.1016/j.ejogrb.2013.10...	NR
Vercellini et al, 2012²⁸28 Vercellini P, Parazzini F, Pietropaolo G, Cipriani S, Frattaruolo MP, Fedele L. Pregnancyoutcome inwomenwithperitoneal, ovarian and rectovaginal endometriosis: a retrospective cohort study. BJOG. 2012;119(12):1538–1543. Doi: 10.1111/j.1471-0528.2012.03466.x https://doi.org/10.1111/j.1471-0528.2012...
Hadfield et al, 2009²⁹29 Hadfield RM, Lain SJ, Raynes-Greenow CH, Morris JM, Roberts CL. Is there an association between endometriosis and the risk of preeclampsia? A population based study. Hum Reprod. 2009;24(09): 2348–2352. Doi: 10.1093/humrep/dep123 https://doi.org/10.1093/humrep/dep123...	NR
Bronsens et al, 2007³⁰30 Brosens IA, De Sutter P, Hamerlynck T, Imeraj L, Yao Z, Cloke B, et al. Endometriosis is associated with a decreased risk of pre-eclampsia. Hum Reprod. 2007;22(06):1725–1729. Doi: 10.1093/humrep/ dem072 https://doi.org/10.1093/humrep/dem072...	OR 6.6; 95% CI 1.2-37
Hjordt Hansen et al, 2007³¹31 Hjordt Hansen MV, Dalsgaard T, Hartwell D, Skovlund CW, Lidegaard O. Reproductive prognosis in endometriosis. A national cohort study. Acta Obstet Gynecol Scand. 2014;93(05):483–489. Doi: 10.1111/aogs.12373 https://doi.org/10.1111/aogs.12373...
Matorras et al, 1998³²32 Matorras R, Rodríguez F, Gutierrez de Terán G, Pijoan JI, Ramón O, Rodríguez-Escudero FJ. Endometriosis and spontaneous abortion rate: a cohort study in infertilewomen. Eur J Obstet Gynecol Reprod Biol. 1998;77(01):101–105. Doi: 10.1016/s0301-2115(97)00181-4 https://doi.org/10.1016/s0301-2115(97)00...

Higher quality studies	Bleeding during pregnancy	Placenta previa	Pre term newborn	Placental retention	Cesarian	Small for gestacional age	Postpartum haemorrhage
Berlac et al, 2017¹⁶16 Berlac JF, Hartwell D, Skovlund CW, Langhoff-Roos J, Lidegaard Ø. Endometriosis increases the risk of obstetrical and neonatal complications. Acta Obstet Gynecol Scand. 2017;96(06): 751–760. Doi: 10.1111/aogs.13111 https://doi.org/10.1111/aogs.13111...	OR 2.3; 95%CI 2.0-2.5	OR 3,9; 95%CI 3.5-4.3	OR 3.1; ,95%CI 2.7-3.6	OR 3.1, 95%CI 1.4-6.6		OR 1.5; 95%CI 1.4-1.6
Glavind et al, 2017¹⁷17 Glavind MT, Forman A, Arendt LH, Nielsen K, Henriksen TB. Endometriosis and pregnancy complications: a Danish cohort study. Fertil Steril. 2017;107(01):160–166. Doi: 10.1016/j.fertnstert. 2016.09.020 https://doi.org/10.1016/j.fertnstert.201...	NR		OR 1.91; 95%CI 1.16-3.15		OR 1.83; 95%CI 1.60-2.09	NR
Saraswat et al, 2017¹⁹19 Saraswat L, Ayansina DT, Cooper KG, Bhattacharya S, Miligkos D, Horne AW, Battacharya S. Pregnancy outcomes in women with endometriosis: a national record linkage study. BJOG. 2017;124 (03):444–452. Doi: 10.1111/1471-0528.13920 https://doi.org/10.1111/1471-0528.13920...	OR 1.67; 95%CI 1.39-2.0	OR 2.24; 95%CI 1,52-3.31	OR 1.26; 95%CI 1.07-1.49		OR 1.4; 95%IC 1.26-1.55	NR	OR 1.30; 95%CI 1.61-1.46
Mannini et al, 2016¹⁸18 Mannini L, Sorbi F, Noci I, Ghizzoni V, Perelli F, Di Tommaso M, et al. New adverse obstetrics outcomes associated with endometriosis: a retrospective cohort study. Arch Gynecol Obstet. 2017; 295(01):141–151. Doi: 10.1007/s00404-016-4222-7 https://doi.org/10.1007/s00404-016-4222-...	NR	OR 0.29; 95%CI 0.10-0.81			NR
Stephansson et al, 2009²⁰20 Stephansson O, Kieler H, Granath F, Falconer H. Endometriosis, assisted reproduction technology, and risk of adverse pregnancy outcome. Hum Reprod. 2009;24(09):2341–2347. Doi: 10.1093/ humrep/dep186 https://doi.org/10.1093/humrep/dep186...			OR 1.33; 95%CI 1.23-1.44
Lower quality studies	Bleeding during pregnancy	Placenta previa	Pre term newborn	Placental retention	Cesarian	Small for gestational age
Turocy et al, 2017²¹21 Turocy J, Farland LV, Yanushpolsky E. Pregnancy outcomes in frozen embryo transfers in women with endometriosis: a retrospective cohort study. Fertil Steril. 2017;108(03):E198. Doi: 10.1016/j.fertnstert.2017.07.584 https://doi.org/10.1016/j.fertnstert.201...
Santulli et al, 2016²²22 Santulli P, Marcellin L, Menard S, Thubert T, Khodhnood B, Gayet V, et al. Increased rate of spontaneous miscarriages in endometriosis- affected women. Hum Reprod. 2016;31(05):1014–1023. Doi: 10.1093/humrep/dew035 https://doi.org/10.1093/humrep/dew035...
Fujii et al, 2016²³23 Fujii T,Wada-Hiraike O, Nagamatsu T, HaradaM, Hirata T, Koga K, et al. Assisted reproductive technology pregnancy complications are significantly associated with endometriosis severity before conception: a retrospective cohort study. Reprod Biol Endocrinol. 2016;14(01):73. Doi: 10.1186/s12958-016-0209-2 https://doi.org/10.1186/s12958-016-0209-...		OR 15.1,;95% CI 4,40-61.7	OR 2.08, 95%CI 1.07-3.89
Jaques et al, 2016⁶6 Jaques AM, Amor DJ, Baker HW, Healy DL, Ukoumunne OC, Breheny S, et al. Adverse obstetric and perinatal outcomes in subfertilewomen conceiving without assisted reproductive technologies. Fertil Steril. 2010;94(07):2674–2679. Doi: 10.1016/j.fertnstert.2010.02.043 https://doi.org/10.1016/j.fertnstert.201...	OR 2.05; 95%CI 1.02-4.11		OR 2.34; 95%CI 1.01-5.41		OR 2.64; 95%CI 1.37-5.07
Lin et al, 2015²⁴24 LinH, Leng JH, Liu JT, Lang JH. Obstetric outcomes inChinesewomen with endometriosis: a retrospective cohort study. Chin Med J (Engl). 2015;128(04):455–458. Doi: 10.4103/0366-6999.151077 https://doi.org/10.4103/0366-6999.151077...		OR 4.51; 95%CI 1.23-16.50	OR 2.42; 95%CI 1,05-5,57		OR 1.93; 95%CI 1.31-2.84	NR
Conti et al, 2014²⁵25 Conti N, Cevenini G, Vannuccini S, et al. Women with endometriosis at first pregnancy have an increased risk of adverse obstetric outcome. J Matern Fetal Neonatal Med. 2015;28(15):1795–1798. Doi: 10.3109/14767058.2014.968843 https://doi.org/10.3109/14767058.2014.96...			OR 2.24; 95%CI 1.46-3.44			OR 2.72; 95%CI 1.46-5.06
Aris et al, 2014²⁶26 Aris A. A 12-year cohort study on adverse pregnancy outcomes in Eastern Townships of Canada: impact of endometriosis. Gynecol Endocrinol. 2014;30(01):34–37. Doi: 10.3109/09513590.2013. 848425 https://doi.org/10.3109/09513590.2013.84...						NR
Mekaru et al, 2013²⁷27 Mekaru K, Masamoto H, Sugiyama H, Asato K, Heshiki C, Kinjyo T, Aoki Y. Endometriosis and pregnancy outcome: are pregnancies complicated by endometriosis a high-risk group? Eur J Obstet Gynecol Reprod Biol. 2014;172:36–39. Doi: 10.1016/j.ejogrb.2013. 10.024 https://doi.org/10.1016/j.ejogrb.2013.10...					NR	NR
Vercellini et al, 2012²⁸28 Vercellini P, Parazzini F, Pietropaolo G, Cipriani S, Frattaruolo MP, Fedele L. Pregnancyoutcome inwomenwithperitoneal, ovarian and rectovaginal endometriosis: a retrospective cohort study. BJOG. 2012;119(12):1538–1543. Doi: 10.1111/j.1471-0528.2012.03466.x https://doi.org/10.1111/j.1471-0528.2012...		OR 5.81; 95%CI 1.53-22.03
Hadfield et al, 2009²⁹29 Hadfield RM, Lain SJ, Raynes-Greenow CH, Morris JM, Roberts CL. Is there an association between endometriosis and the risk of preeclampsia? A population based study. Hum Reprod. 2009;24(09): 2348–2352. Doi: 10.1093/humrep/dep123 https://doi.org/10.1093/humrep/dep123...
Bronsens et al, 2007³⁰30 Brosens IA, De Sutter P, Hamerlynck T, Imeraj L, Yao Z, Cloke B, et al. Endometriosis is associated with a decreased risk of pre-eclampsia. Hum Reprod. 2007;22(06):1725–1729. Doi: 10.1093/humrep/ dem072 https://doi.org/10.1093/humrep/dem072...
Hjordt Hansen et al, 2007³¹31 Hjordt Hansen MV, Dalsgaard T, Hartwell D, Skovlund CW, Lidegaard O. Reproductive prognosis in endometriosis. A national cohort study. Acta Obstet Gynecol Scand. 2014;93(05):483–489. Doi: 10.1111/aogs.12373 https://doi.org/10.1111/aogs.12373...
Matorras et al, 1998³²32 Matorras R, Rodríguez F, Gutierrez de Terán G, Pijoan JI, Ramón O, Rodríguez-Escudero FJ. Endometriosis and spontaneous abortion rate: a cohort study in infertilewomen. Eur J Obstet Gynecol Reprod Biol. 1998;77(01):101–105. Doi: 10.1016/s0301-2115(97)00181-4 https://doi.org/10.1016/s0301-2115(97)00...

[1] Address for correspondence Giuliana Annicchino, MD, Hospital Israelita Albert Einstein, São Paulo, Brazil (e-mail: giuliana.annicchino@einstein.com).

Brasil

Brasil

Existe um risco maior para desfechos obstétricos desfavoráveis em mulheres com endometriose? Uma avaliação das evidências

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Objetivo

Conclusão