There is no doubt that ensuing pregnancies with chronic pelvic pain with, or without, endometriosis, suffer significant complications (Stephansson, 2009).
In this study there were 13,090 singleton births among 8922 women diagnosed with endometriosis from a national database of over one million pregnancies. Compared with women without endometriosis, women with endometriosis had higher risks of preterm birth [OR 1.33]. Among women with endometriosis 11.9% conceived after ART compared with 1.4% of women without endometriosis. The risk of preterm birth associated with endometriosis among women with ART was 1.24, and among women without ART 1.37. Women with endometriosis had higher risks of antepartal bleeding/placental complications, pre-eclampsia and Caesarean section. There was no association between endometriosis and risk of SGA-birth or stillbirth.
Another, under-rated complication is pain during the pregnancy. Often labelled as “SPD” or “symphysis pubis dysfunction”, many parous women – with prior uterosacral injuries or levator injuries – suffer recurrent pain in subsequent pregnancies, particularly if there has been a prolonged, inter-pregnancy interval. Such pain may start as early as 20 weeks, be particularly persistent, and refractory to treatment.