Katoza E, Soriano D, Stockheim D et al.

Endometriosis affects 10% of women in reproductive age group. Though rare, it can complicate pregnancy. This was a retrospective case series of 3 women, from a review of 800 women attending an endometriosis clinic in Israel, who experienced severe complications in pregnancy.

All three were between 26-29 weeks gestation, and had conceived through in-vitro fertilisation and embryo transfer. All presented with severe abdominal pain not relieved by tocolytic and analgesia. There were signs of hypovolemia and marked reduction in hemoglobin values without evident bleeding.

Exploratory laparotomy was performed in all cases. Haemoperitoneum was found in all cases and blood transfusion was required, with one of them requiring ‘massive transfusion of blood products’. Severe fetal complications occurred in all three.

As a diagnosis of endometriosis was made before pregnancy in two cases, and endometriosis and pelvic adhesions were observed in all, hemoperitoneum was believed to be due to severe endometriosis. None of these cases had any signs of vascular abnormality.

The authors make a case for close follow up of women with severe endometriosis who undergo in-vitro fertilisation, as they may be at increased risk for intra abdominal bleeding in third trimester. An experienced surgical team would appear to be most useful, if intervention is required.

Symptomatic endometriosis in pregnancy is relatively rare. This case series however, emphasise the need to be aware of its possible consequences in women with known severe disease.