The impact of endometriosis on pregnancy and childbirth

The literature suggests about the possible adverse effects of endometriosis on pregnancy, birth and the early postpartum period. So, the well-known observations of spontaneous abortion and premature delivery [Endometriosis as a cause..., 1948; E. Bennet, 1953]. On the basis of endometriosis can occur rupture of the uterus during pregnancy and childbirth [R. Schafer, 1918; R. Richardson, 1919; M. Stone, 1938; Scott R., 1944; Soergel W., 1956, and others]. L. F. shinkareva (1958) reasonably believes that the decidual transformation in the field of foci of endometriosis in pregnant uterus can facilitate a deeper germination of chorionic villi in thickness of the uterus.
Genital endometriosis, especially diffuse adenomyosis of the uterus, can reduce the contractile function of the uterus and cause weakness generic activities, bleeding in succession and early postnatal periods. Spontaneous rupture of endometrioid ovarian cysts can cause the development of acute abdomen at any stage of pregnancy.
P. Clement (1977) described spontaneous perforation of the sigmoid colon in the lesion her endometriosis, in a 28-year-old woman at 37 weeks of pregnancy. The sick were carried laparotomy and resection of part of the sigmoid colon overlay colostomy.
U. A. Rahim (1975) published observation, when the 23-year-old woman who previously had a caesarean section, endometriosis in the wall of the uterus with the onset of labor simulated picture of the inferiority of the scar and the beginning of uterine rupture. During repeated cesarean section signs of inferiority scar in the wall of the uterus was not found. No signs of a break in esecanna the scar was confirmed histologically.

endometriosis cancer
Fig. 12. Adenomyosis (endometriosis) bottom and body of the uterus and cervico-isthmus pregnancy , the patient R. (I. K. the Vachnadze)

I. K. the Vachnadze (1959) presented the case of development isthmus-cervical pregnancy 36-year-old patient R. suffering before the pregnancy with algodismenorrhea. In history it was 14 pregnancies (1 childbirth, 10 artificial and 3 of spontaneous abortion). Because of heavy uterine bleeding was hysterectomy without appendages. The bottom and the body of the uterus affected by endometriosis (adenomyosis), the size of the uterine cavity is reduced. Prodovolstvie was located in the isthmus-cervical Department of the uterus and significantly increased its size (Fig. 12).
An example of an extremely severe complications caused by endometriosis, can serve the following observation, published with permission of administration of the Novgorod regional hospital. In conducting the patient was attended by doctors And. Century Gukova, C. X. Vainshtein, V. N. Hamusica. The author of the monograph acted as a reviewer and together with colleagues tried to explain the pathogenesis of the unfolding tragedy.
Pervouralskaya A., 22 years old, was brought ambulances 03.02.83, in the surgical Department of the Novgorod regional hospital about pulmonary hemorrhage during pregnancy 29-30 weeks. Intensive hemoptysis began on the night of 02.02 on 03.02.83, Under the influence of hemostatic therapy conducted in the period from 03 to 07.02.83 year, hemoptysis has decreased, and then stopped. When bronchoscopic examination in the bronchial tree found redness of the mucous membrane and parietal blood clots. In satisfactory condition 16.02.83, A. was discharged home with progressive pregnancy.
Monthly 15 years, in 3-4 days, through 27-28 days. The pregnancy 16-17 weeks was conducted inpatient care about threatening miscarriage. It is established that the periodic expectoration of sputum with blood were observed before she was married and had continued in the future. With the onset of pregnancy hemoptysis has stopped, however, as indicated above, it was resumed during the period 29-30 weeks.
19.02.83 was sick again taken to the surgical Department of the hospital with recurrent pulmonary hemorrhage and phenomena of threatened abortion. Under the influence of hemostatic therapy hemoptysis stopped. When re bronchoscopy 25.02.83, in the proximal the bronchus found fresh blood clots.
26.02.83, hemoptysis resumed and intensified, and 01.03. 83 he developed pulmonary bleeding, about which produced an urgent surgery - right-hand bottom lobectomy. At the moment the suturing wounds began massive bleeding through an endotracheal tube, possibly from the remaining part of the right lung, and therefore made the right pulmonate. The bleeding has stopped, however, due to the obstruction of blood left lung bronchi to establish its ventilation failed, and after 2 hours and 20 minutes from the start of operations death, despite intensive resuscitation.
In macroscopic examination of the remote right lung obvious source of bleeding is not revealed. Noteworthy is the fact that pulmonary bleeding started following the signs of threatened abortion. The fruit died from intrauterine hypoxia.
Histologically in the lumen of the small and large bronchi remote light and in the alveoli blood. Pockets of atelectasis alternate with foci of emphysema. Tissue around the individual bronchi fibrosarcoma, with the gemosideros and lymphomassage, infiltration. Near other bronchi field descaling tissue in a state of degeneration and decay. In the ovaries - small foci of endometriosis with decidual the metamorphosis in a state of degeneration. Uterus: the thicker gravidarum-generirovanie Oxytocics endometrial cancer reaction arias - Stella.
Patologicheskoi study of the right lung in the Institute of obstetrics and gynecology at the AMS of the USSR and the all-Russian research Institute of pulmonology the USSR Ministry of health made it impossible to establish the nature of the pathology. In the study of other parts of micropreparations light at the Department of pathological anatomy of Zaliv in Moscow were found: peribronchial in several areas there were structural elements of endometrial tissue; uterine cancer type, surrounded by tithenai the stroma. In some parts, the endometrial tissue with decidual the metamorphosis, others with hemorrhagic soaking and by the collapse or fibrosis, Sideroom and inflammatory infiltration. Bronchial and alveolar - blood. The source of bleeding, apparently, was eroded by endometriosis vessels of the lungs. That judgment is based on the pathogenesis of the defeat of this localization.

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