O-253 Obstetric outcome after endometriosis surgery with parametrial involvement and uterine artery section or occlusion: a prospective observational study

Abstract

Study question Does the uterine devascularization related to uterine artery section or coagulation during parametrial endometriosis surgery influence the obstetric outcome in the future? Summary answer Uterine devascularization during surgery for parametrial endometriosis is related to a significantly higher frequency of preterm birth, gestational hypertension, preeclampsia, and placenta previa. What is known already Endometriosis may require surgical treatment because of pain or organ damage. Surgery for deep endometriosis, included parametrectomy, is regulary performed in referral centers and may preceed spontaneous or assisted conception. Removal of parametrial endometriosis, in particular surrounding ureters, may require sacrificing uterine vessels, with a potentially increased risk of pregnancy complications in the future.While endometriosis is itself related to an enhanced risk of several obstetric complications, including premature labor, small for gestational age (SGA) infants, intrauterine growth restriction (IUGR), hypertensive disorders, placenta previa and obstetric bleeding, little is known about the influence of surgery on obstetric outcome. Study design, size, duration A single-center prospective observational study (Etics Committe approval: OB-END-VASC - Prog. 362CET) performed in a Referral Center for Endometriosis. All consecutive patients, who underwent surgery for endometriosis with parametrectomy from January 2010 to December 2023 were invited to participate. Inclusion criteria were: age 23-46 years, pregnancy after surgery, informed consent to study participation. Surgical data analyzed included uterine devascolarization, associated surgical procedures, concomitant adenomyosis. Obstetric data included modality of conception, pregnancy and delivery outcome. Participants/materials, setting, methods During the study period, a total of 3989 women underwent laparoscopic parametrectomy for deep endometriosis in Our Refferal Center for Endometriosis (IRCCS Sacred Heart Hospital, Negrar). A total of 594 women who experienced at least one pregnancy after surgery, completed the follow-up and informed consent, and these participants were ultimately included in the study. Two groups of patients could be identified: PV group (preserved vascularization) and UD group (uterine devascularization related to uterine artery section/occulsion). Main results and the role of chance Out of 594 women, 88.05% (523/594) underwent parametrectomy with preservation of both uterine arteries (PV group), whereas in 11.95 % patients (71/594) parametrectomy was accompanied by uterine devascularization (UD group) which was achieved through coagulation 35.2% (25/71), application of clips 15.5 % (11/71), or a combination of sectioning with coagulation/clipping 49.30% (35/71), either unilaterally 92.96% or bilaterally 7.04% (66/71 vs 5/71). The overall preterm birth rate was 14.2%, with 29.5 % occurring in the UD- group compared to 12.2%in the PV-group. (p < 0.001) Gestational hypertension and preeclampsia were observed in 19.7% and 8.2% of cases in the UD-group, compared to rates of 8.06% (p = 0.008) and 2.4% (p = 0.030) in the PV-group. Placenta previa was found in 14.8% in the group of uterine devascularization, versus 7.2% in the other (p = 0.044). Using logistic regression models, a possible confounding effect of adenomyosis on the rate of pregnancy complications among groups was exclued. This analysis confirmed an increased risk among patients in the UD-group for hypertension, preeclampsia, placenta previa and preterm birth, along with a nearly significant increase in the risk of fetal growth disorders. No statistically significant associations were found between other pregnancy complications (such as diabetes, placental abruption, PAS disorders, postpartum hemorrhage, and retained placenta) and uterine devascularization Limitations, reasons for caution While surgery for endometriosis in all cases was performed in the same, Refferal Center, we can not guarantee an homogeneous, standardized, and qualified approach to pregnancy management as patients delivered in different hospitals from all italian territory. Wider implications of the findings To the best of our knowledge, this is the first study assessing the impact of uterine devascularization during parametrectomy for endometriosis on pregnancy outcomes. It is crucial for clinicians to understand the effects of radical surgery, for counseling patients regarding potential risks, especially in cases of extensive disease. Trial registration number No