子宮内膜症患者における産科合併症と転帰

Obstetrical complications and outcome in patients with endometriosis.

• Anna V Borisova
• Setonde Romeo D Konnon
• Valentina Tosto
• Sandro Gerli
• Viktor E Radzinsky

抄録

子宮内膜症は、慢性的な骨盤の痛み、月経困難症、月経困難症、不妊症を伴うため、女性の生活の質に大きな影響を与える病気です。しかし、待望の妊娠（多くの場合、生殖補助技術を用いた後）を得ても、子宮内膜症の患者は、流産、早産、子癇前症、胎盤異常、陣痛時の出血、妊娠年齢の低い乳児の出産、死産、帝王切開率の上昇などの産科合併症のリスクが高い。また、妊娠中に子宮内膜症の急性合併症として、自然血栓症などが起こることがありますが、これは稀ですが命に関わる状態であり、ほとんどの場合は外科的介入を必要とします。子宮内膜症の妊婦で観察される合併症のメカニズムは完全には解明されていない。本レビューでは、子宮内膜症が妊娠転帰や合併症の発生に及ぼす影響について、文献データと個人的な考察を提示するとともに、それらの可能性のある下線部のメカニズムについても検討した。これに基づき、子宮内膜症の既往歴のある妊婦における産科合併症のリスクを軽減する方法を提案した。

Endometriosis is a disease that has a profound impact on the quality of life of women, due to the associated chronic pelvic pain, dysmenorrhea, dyspareunia and infertility. However, even getting long-awaited pregnancy (often after assisted reproductive technologies), patients with endometriosis have a high risk of obstetric complications, such as miscarriage, preterm birth, preeclampsia, placental abnormalities, hemorrhage in labor, birth of small for gestational age infants, stillbirth and higher cesarean section rate. In addition, during pregnancy acute complications of endometriosis may occur, such as spontaneous hemoperitoneum, which is rare but life-threatening conditions that in most cases require surgical intervention. The mechanisms of the observed complications in pregnant women with endometriosis are not fully understood. This review presents literature data and personal considerations on the effect of endometriosis on pregnancy outcome and the occurrence of complications, as well as their possible underlined mechanisms. Based on this, we proposed ways to reduce the risk of obstetric complications in pregnant women with a history of endometriosis.