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2171 Need for Fertility Preservation in Woman with Endometriosis
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Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Study Objective: To report the prevalence of abnormal appendiceal pathology in women with pelvic pain and pathology-confirmed pelvic endometriosis. Design: Retrospective case series. Setting: Tertiary care referral center. Patients or Participants: Forty patients with pelvic pain undergoing laparoscopy for possible endometriosis with concomitant laparoscopic appendectomy during a 5 month period. Interventions: Laparoscopic excision of suspected endometriosis with concomitant laparoscopic appendectomy on patients with visible abnormalities of the appendix. Measurements and Main Results: Forty patients underwent laparoscopic excision of suspected endometriosis with visible abnormalities involving the appendix and were treated with concomitant laparoscopic appendectomy. Of this subgroup, thirty-eight patients had pelvic endometriosis and eighteen patients (47.3%) had appendiceal pathology: seven (18%) with pathology-confirmed appendiceal endometriosis, three (7.9%) with carcinoid neuroendocrine tumor, two (5.3%) with acute appendicitis, two (5.3%) with mild acute inflammation, two (5.3%) with lymphoid hyperplasia, and two (5.3%) with fibrous obliteration. The prevalence of appendiceal pathology in patients with pelvic endometriosis was 47.3%. Conclusion: Appendiceal pathology may be a contributing factor to pelvic pain in women with endometriosis and should be routinely inspected for visible abnormalities.
patients with multiple prior surgeries (range 2 to >5) more frequently had small for gestational age infants (32% vs. 14%, p=0.015), which was independent of gestational age. There were no significant differences in obstetric outcomes (gestational age, delivery method or newborn weight) by type of endometriosis surgery. Conclusion: More extensive surgical history, as evidenced by multiple prior endometriosis surgeries, was associated with having infants who were small for gestational age.
Virtual Poster Session 3: Endometriosis (10:20 AM − 10:30 AM) 10:20 AM: STATION D 2756 Obstetric Outcomes in a Contemporary Cohort of Women with Endometriosis at an Academic Medical Center Orlando M,1,* Blat C,1 Rosenstein M,1 Opoku-Anane J2. 1Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA; 2Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA *Corresponding author. Study Objective: Previous literature shows that women with endometriosis have higher rates of adverse pregnancy outcomes compared to the general population, including preterm birth, fetal growth restriction, and cesarean section. We aim to identify disease-specific risk factors and surgical treatments that impact obstetric outcomes. Design: Retrospective cohort study. Setting: Academic medical center. Patients or Participants: Women who delivered at our institution from January 2002 to December 2018 with ICD-9/10 codes of endometriosis. Interventions: We obtained demographic characteristics and pregnancy information from a prospectively-maintained dataset, and linked this to gynecologic data, including symptoms, infertility treatments, lesion types (superficial, deeply-infiltrative [DIE], endometrioma, adenomyosis), and prior surgeries for endometriosis—dichotomous variables for diagnostic laparoscopy, ablation/fulguration, ovarian cystectomy, superficial excision, and excision of DIE. Patients were stratified by gynecologic characteristics, and obstetric outcomes compared across groups. Measurements and Main Results: Of 148 deliveries, 54 (36%) had superficial endometriosis, 14 (9.5%) DIE, 75 (51%) endometriomas, and 13 (8.8%) adenomyosis. Compared to other lesions, adenomyosis was associated with prior miscarriage (62% vs. 22%, p=0.004). Almost threequarters (72%) of patients had undergone previous surgery, including 68% diagnostic laparoscopy, 22% ablation, 28% cystectomy, 8.8% superficial excision, and 4.1% DIE excision. 38% had previously been diagnosed with infertility, while 28% conceived through in vitro fertilization. Women with DIE more often delivered via cesarean section (71% vs. 40%, p=0.044). Compared to patients with zero or one prior surgery, the 25
Virtual Poster Session 3: Endometriosis (10:20 AM − 10:30 AM) 10:20 AM: STATION E 2171 Need for Fertility Preservation in Woman with Endometriosis Bubak-Dawidziuk JB*. Gynecology and Oncological Gynecology Department, Holy Family Hospital, Warsaw, Poland *Corresponding author. Study Objective: To evaluate the impact of endometriosis for ovarian reserve via measurements of serum anti-M€ullerian hormone, follicle stimulating hormone, estradiol and to indicate groups of patients where fertility preservation should be considered. Design: From August 2017 to July 2018 a prospective cohort study was performed. It included 50 patients below 35 years with confirmed endometriosis who were followed by laparoscopic surgery. AMH, FSH and Estradiol levels were assessed before and approximately one month after surgery. The stage of endometriosis was evaluated by rAFS and rEnzian classification. Setting: N/A. Patients or Participants: N/A. Interventions: All patients filled in a questionnaire of medical history and previous treatment. Afterwards they underwent laparoscopic removal of all endometriotic lesions. Post operatively they were divided into groups using rAFS and rEnzian classification. Measurements and Main Results: The AMH level of operated patients was importantly reduced after surgery (from 2.95 § 2.14 [mean § SD] at baseline to 1.05 § 1.56 at follow-up). There was a statistically significant correlation between the rate of serum AMH decline and stage of endometriosis according to rAFS classification (p=0,014). The decline was about 0,31 § 0,8 [mean § SD]; 0,08 § 0,64; 1,68 §1,44; 1,38§ 1,9 respectively in group I, II, III, IV. In addition, patients with bilateral ovarian endometriomas showed the highest decline of AMH levels compared with unilateral ovarian endometriosis (about 2,16 § 2,45 in bilateral group; about 1,42 §1,31 in unilateral endometriosis). However, also patients who were not observed with cysts had a decreased level of AMH after surgery about 0,44 § 1,2. FSH and Estradiol levels were not statistically significant. Conclusion: The rate of serum AMH is significant indicator of ovarian reserve. It should be marked before all endometriosis surgeries as its level might be declined even in minimal and mild stages. Since it is reduced postoperatively all patients with endometriosis should be offered fertility preservation techniques. Virtual Poster Session 3: Endometriosis (10:20 AM − 10:30 AM) 10:20 AM: STATION F 2406 The Role of Exercise in Decreasing Ongoing Pain in the Post-Excision Endometriosis Population Sarrel S*. Sarrel Physical Therapy, New York, NY *Corresponding author. Study Objective: Endometriosis is a painful disease affecting quality of life in nearly 176 million women worldwide. Even post excision of endometriosis patients may continue to experience pain across multiple systems
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Study Objective: To report the prevalence of abnormal appendiceal pathology in women with pelvic pain and pathology-confirmed pelvic endometriosis. Design: Retrospective case series. Setting: Tertiary care referral center. Patients or Participants: Forty patients with pelvic pain undergoing laparoscopy for possible endometriosis with concomitant laparoscopic appendectomy during a 5 month period. Interventions: Laparoscopic excision of suspected endometriosis with concomitant laparoscopic appendectomy on patients with visible abnormalities of the appendix. Measurements and Main Results: Forty patients underwent laparoscopic excision of suspected endometriosis with visible abnormalities involving the appendix and were treated with concomitant laparoscopic appendectomy. Of this subgroup, thirty-eight patients had pelvic endometriosis and eighteen patients (47.3%) had appendiceal pathology: seven (18%) with pathology-confirmed appendiceal endometriosis, three (7.9%) with carcinoid neuroendocrine tumor, two (5.3%) with acute appendicitis, two (5.3%) with mild acute inflammation, two (5.3%) with lymphoid hyperplasia, and two (5.3%) with fibrous obliteration. The prevalence of appendiceal pathology in patients with pelvic endometriosis was 47.3%. Conclusion: Appendiceal pathology may be a contributing factor to pelvic pain in women with endometriosis and should be routinely inspected for visible abnormalities.
patients with multiple prior surgeries (range 2 to >5) more frequently had small for gestational age infants (32% vs. 14%, p=0.015), which was independent of gestational age. There were no significant differences in obstetric outcomes (gestational age, delivery method or newborn weight) by type of endometriosis surgery. Conclusion: More extensive surgical history, as evidenced by multiple prior endometriosis surgeries, was associated with having infants who were small for gestational age.
Virtual Poster Session 3: Endometriosis (10:20 AM − 10:30 AM) 10:20 AM: STATION D 2756 Obstetric Outcomes in a Contemporary Cohort of Women with Endometriosis at an Academic Medical Center Orlando M,1,* Blat C,1 Rosenstein M,1 Opoku-Anane J2. 1Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA; 2Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA *Corresponding author. Study Objective: Previous literature shows that women with endometriosis have higher rates of adverse pregnancy outcomes compared to the general population, including preterm birth, fetal growth restriction, and cesarean section. We aim to identify disease-specific risk factors and surgical treatments that impact obstetric outcomes. Design: Retrospective cohort study. Setting: Academic medical center. Patients or Participants: Women who delivered at our institution from January 2002 to December 2018 with ICD-9/10 codes of endometriosis. Interventions: We obtained demographic characteristics and pregnancy information from a prospectively-maintained dataset, and linked this to gynecologic data, including symptoms, infertility treatments, lesion types (superficial, deeply-infiltrative [DIE], endometrioma, adenomyosis), and prior surgeries for endometriosis—dichotomous variables for diagnostic laparoscopy, ablation/fulguration, ovarian cystectomy, superficial excision, and excision of DIE. Patients were stratified by gynecologic characteristics, and obstetric outcomes compared across groups. Measurements and Main Results: Of 148 deliveries, 54 (36%) had superficial endometriosis, 14 (9.5%) DIE, 75 (51%) endometriomas, and 13 (8.8%) adenomyosis. Compared to other lesions, adenomyosis was associated with prior miscarriage (62% vs. 22%, p=0.004). Almost threequarters (72%) of patients had undergone previous surgery, including 68% diagnostic laparoscopy, 22% ablation, 28% cystectomy, 8.8% superficial excision, and 4.1% DIE excision. 38% had previously been diagnosed with infertility, while 28% conceived through in vitro fertilization. Women with DIE more often delivered via cesarean section (71% vs. 40%, p=0.044). Compared to patients with zero or one prior surgery, the 25
Virtual Poster Session 3: Endometriosis (10:20 AM − 10:30 AM) 10:20 AM: STATION E 2171 Need for Fertility Preservation in Woman with Endometriosis Bubak-Dawidziuk JB*. Gynecology and Oncological Gynecology Department, Holy Family Hospital, Warsaw, Poland *Corresponding author. Study Objective: To evaluate the impact of endometriosis for ovarian reserve via measurements of serum anti-M€ullerian hormone, follicle stimulating hormone, estradiol and to indicate groups of patients where fertility preservation should be considered. Design: From August 2017 to July 2018 a prospective cohort study was performed. It included 50 patients below 35 years with confirmed endometriosis who were followed by laparoscopic surgery. AMH, FSH and Estradiol levels were assessed before and approximately one month after surgery. The stage of endometriosis was evaluated by rAFS and rEnzian classification. Setting: N/A. Patients or Participants: N/A. Interventions: All patients filled in a questionnaire of medical history and previous treatment. Afterwards they underwent laparoscopic removal of all endometriotic lesions. Post operatively they were divided into groups using rAFS and rEnzian classification. Measurements and Main Results: The AMH level of operated patients was importantly reduced after surgery (from 2.95 § 2.14 [mean § SD] at baseline to 1.05 § 1.56 at follow-up). There was a statistically significant correlation between the rate of serum AMH decline and stage of endometriosis according to rAFS classification (p=0,014). The decline was about 0,31 § 0,8 [mean § SD]; 0,08 § 0,64; 1,68 §1,44; 1,38§ 1,9 respectively in group I, II, III, IV. In addition, patients with bilateral ovarian endometriomas showed the highest decline of AMH levels compared with unilateral ovarian endometriosis (about 2,16 § 2,45 in bilateral group; about 1,42 §1,31 in unilateral endometriosis). However, also patients who were not observed with cysts had a decreased level of AMH after surgery about 0,44 § 1,2. FSH and Estradiol levels were not statistically significant. Conclusion: The rate of serum AMH is significant indicator of ovarian reserve. It should be marked before all endometriosis surgeries as its level might be declined even in minimal and mild stages. Since it is reduced postoperatively all patients with endometriosis should be offered fertility preservation techniques. Virtual Poster Session 3: Endometriosis (10:20 AM − 10:30 AM) 10:20 AM: STATION F 2406 The Role of Exercise in Decreasing Ongoing Pain in the Post-Excision Endometriosis Population Sarrel S*. Sarrel Physical Therapy, New York, NY *Corresponding author. Study Objective: Endometriosis is a painful disease affecting quality of life in nearly 176 million women worldwide. Even post excision of endometriosis patients may continue to experience pain across multiple systems