Endometriosis · Pathophysiology
Abstract
Aim
Aim this study was to evaluate the incidence of endometriosis in women with a recent history of surgical site infections (SSIs), and obstetric and gynecological surgical procedures.
Materials and Methods
A retrospective multicenter cohort was conducted on patients who have had obstetric or gynecological surgical procedures performer from January 2022 to December 2024 in 16 hospitals from six Ukrainian regions. Definitions of SSIs were adapted from the Centers for Disease Control and Prevention's National Healthcare Safety Network. The criteria for endometriosis were adapted from the ESHRE endometriosis guideline.
Results
The study included 33,126 reproductive women with endometriosis who had 16,724 obstetric and 32,383 gynecologic surgical procedures. The incidence of endometriosis in women with history of obstetric and gynecologic surgical procedures, and SSIs was 25.5% [95% confidence interval (CI), 24.3-26.4], 33.3% (95% CI, 33.0-33.6), and 22,1% (20.8-24.2), respectively. Multivariate analysis identified SSIs, obstetric and gynecological surgical procedures as three factors positively associated with the risk of endometriosis. Factors that increased the odds of endometriosis was SSIs (adjusted odds ratio [AOR], 3.76; 95% CI, 2.29-6.20), and obstetric and gynecological surgical procedures (AOR, 7.91; 95% CI, 3.68-37.3). An SSIs and obstetric and gynecological surgery history increased the odds of an endometriosis >7-fold in the cohort (AOR, 7.96; 95% CI, 3.64-37.2).
Conclusions
Obstetric and gynecological surgical injury, and the inflammation resulting from SSIs may play a role in developing endometriosis.
Topics
By this author
Infections · Vaginal and Cervical Infections
Urinary tract infections in pregnant women from the Russian--Ukrainian military conflict regions: A multicenter study (2022-2025)
Salmanov AG et al., 2026 · Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego
To estimates of the prevalence rate of urinary tract infections (UTIs) in pregnant women from the Ukrainian-Russian military conflict regions and antimicrobial resistance of causing pathogens. Materials and Retrospective multicenter cohort study was conducted from April, 2022 to May, 2025.The study population consisted of 2,576 pregnant women from the Ukrainian-Russian military conflict regions. Antibiotic susceptibility was done by the disc diffusion test as recommended by EUCAST guidelines. Among 2,576 pregnant women, 1,002 (38.9%) UTIs were observed. The most frequently reported UTI types were cystitis (48.4%) and asymptomatic bacteriuria (39%). Of all UTI cases, 14.6% were defined as acute pyelonephritis. The most common causative agents of UTIs were Escherichia coli (27.6%), Klebsiella pneumoniae (13.9%), Proteus mirabilis (11.2%), Coagulase-negative staphylococci (8.7%), Enterococcus faecalis (8.5%), Enterobacter spp. (7.2%), and Pseudomonas aeruginosa (6.6%). Methicillin-resistance S. aureus (MRSA), vancomycin resistance enterococci (VRE), and extended spectrum beta-lactamases (ESBL) production among Enterobacteriales was found observed in 11.3%, 9.1%, and 29.4% isolates, respectively. Carbapenem resistance was identified in 13.7% of P. aeruginosa strains. This study findings demonstrate the high rate of UTIs in pregnant women from the Ukrainian-Russian military conflict regions and many cases are caused by pathogens that are resistant to antibiotics. Strategies for deterrence include optimal hygiene practices to minimize the risk of bacterial colonization and ascending infection.
Infections · Pelvic Inflammatory Disease
Complications and adverse outcomes related to induced abortion in female from the Ukrainian-Russian military conflict regions: A multicentre study
Salmanov AG et al., 2025 · Wiadomosci lekarskie (Warsaw, Poland : 1960)
To provide an overview of complications and adverse outcomes related to induced abortion in female from the Eastern and Southern Ukrainian-Russian military conflict regions. Material and This are a multicentre combined retrospective and prospective cohort study. All women who underwent induced abortion in Eastern and Southern Ukrainian-Russian military conflict regions between 2022 and 2024 are included in the study. A total of 14,196 induced abortion were performed, 10,630 (74.9%) complications cases were observed. The most complication were infections (71.1%), cervical injury (6.6%), incomplete abortion (5.4%), hemorrhage (5.2%), and uterine perforation (4.9%). The most common infection related to induced abortions was endometritis (21.6%), cervicitis (17.8%), vaginal cuff infections (16.3%), peritonitis (12.3%) and pelvic abscess (10.7%), followed by adnexa utery (8.1%), parametritis (6.7%), salpingitis (5.1%), sepsis (1.3%) and other (0.2%) infections. The main risk factors was increased maternal age, surgical abortion approach, increased gestational age, prior cesarean delivery, presence of a bleeding disorder, fetal demise before the abortion, lack of healthcare facilities, lack of essential medication, lack of personnel and equipment, and surgical inexperience. This study findings demonstrate the high rate of complications related to induced abortion in the Ukrainian-Russian military conflict regions. The ongoing war has led to a decline in the quality of healthcare services and main reason for the high rate of complications and adverse outcomes related to induced abortion in female from the military conflict regions.
Diagnosis · Staging and Classification
Epidemiology of endometriosis in female evacuated from the Eastern Ukrainian military conflict regions: results a multicenter study (2022-2024)
Salmanov AG et al., 2025 · Wiadomosci lekarskie (Warsaw, Poland : 1960)
To estimate the prevalence and risk factors associated with endometriosis in female evacuated from the Eastern Ukrainian military conflict regions. Materials and A prospective multicenter cohort study was based on surveillance data for endometriosis. 982 women undergoing pelvic surgery were compared to 264 patients unexposed to surgery. The study cohort included women, who underwent a diagnostic and/or therapeutic laparoscopy or laparotomy in 2022-2024. Endometriosis among women was diagnosed visually at laparoscopy/laparotomy or by pelvic magnetic resonance imaging. The prospective multicenter study included 1,246 women. The overall prevalence of endometriosis was 31.5%. Prevalence of the three types of endometrioses included peritoneal/superficial endometriosis, ovarian endometriotic cyst/endometrioma and deep infiltrating endometriosis was 13.8%, 9.8%, and 4.8%, respectively. Three hundred sixty-one women 36,8% in the surgical group and thirty-one women 13.3% in the community treatment group (unexposed to surgery, population cohort) were diagnosed with incident endometriosis. The pelvic pain, infertility and early age at menarche to be a consistent risk factor for endometriosis in both the operative and population cohorts. Data analysis showed that odds were decreased for gravidity, parity, and BMI. Factors that increased the odds of endometriosis diagnosis included dysmenorrhea, older age at first sex, pelvic pain as a surgical indication for laparoscopy, and higher education. Our study findings demonstrate the high prevalence of endometriosis among women in Ukraine. The pelvic pain, infertility and early age at menarche to be a consistent risk factor for endometriosis in both the operative and population cohorts.
Associated Conditions · Extrapelvic Endometriosis
Abdominal wall endometriosis in Ukraine: A multicenter study
Salmanov AG et al., 2025 · Wiadomosci lekarskie (Warsaw, Poland : 1960) · Free to read
To estimate the incidence of abdominal walls endometriosis in Ukraine and review the clinical findings, imaging results, and histopathology of patients who have had cesarean scar endometriosis. Materials and We performed multicentre retrospective cohort study from January 2020 to December 2024. The study involved 27 hospitals from 10 regions of Ukraine and included 9,157 reproductive women who had a painful mass in their previous abdominal surgery scar area. Definitions of endometriosis were adapted from the WHO. Among 9,157 patients, 387 (4.2%) abdominal walls endometriosis (AWE) were observed. Of all cases 82.2% women had cesarean scar endometriosis and 17.8% had scar endometriosis related to gynecologic surgical procedure. The incidence of AWE associated with history of cesarean section, gynecological abdominal hysterectomy and laparoscopic procedures was 6.3%, 2.3%, and 1.2%, respectively. The main symptoms of scar endometriosis were palpable abdominal mass (100%) and cyclic pain (86.8%). The latency period between cesarean section procedure and of cesarean scar endometriosis (CSE) symptom onset was 31.8 ± 23.6 months. The duration between the onset of symptoms of CSE and this surgery was 28.7 ± 25.4 months. The diagnosis of CSE was made through a histopathological examination. In Ukraine abdominal wall endometriosis (AWE), is a relatively uncommon entity that usually develops at the site of a surgical scar that occurs after obstetric or gynecologic surgeries. In our study the most frequently of all AWE cases was cesarean scar endometriosis.
Related research
Diagnosis · Imaging
Risk factors associated with endometriosis: importance of study population for characterizing disease in the ENDO Study
Peterson CM et al., 2013 · Am J Obstet Gynecol · Free full text on PubMed Central
We sought to identify risk factors for endometriosis and their consistency across study populations in the Endometriosis: Natural History, Diagnosis, and Outcomes (ENDO) Study. In this prospective matched, exposure cohort design, 495 women aged 18-44 years undergoing pelvic surgery (exposed to surgery, operative cohort) were compared to an ageand residence-matched population cohort of 131 women (unexposed to surgery, population cohort). Endometriosis was diagnosed visually at laparoscopy/laparotomy or by pelvic magnetic resonance imaging in the operative and population cohorts, respectively. Logistic regression estimated the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for each cohort. The incidence of visualized endometriosis was 40% in the operative cohort (11.8% stage 3-4 by revised criteria from the American Society for Reproductive Medicine), and 11% stage 3-4 in the population cohort by magnetic resonance imaging. An infertility history increased the odds of an endometriosis diagnosis in both the operative (AOR, 2.43; 95% CI, 1.57-3.76) and population (AOR, 7.91; 95% CI, 1.69-37.2) cohorts. In the operative cohort only, dysmenorrhea (AOR, 2.46; 95% CI, 1.28-4.72) and pelvic pain (AOR, 3.67; 95% CI, 2.44-5.50) increased the odds of diagnosis, while gravidity (AOR, 0.49; 95% CI, 0.32-0.75), parity (AOR, 0.42; 95% CI, 0.28-0.64), and body mass index (AOR, 0.95; 95% CI, 0.93-0.98) decreased the odds of diagnosis. In all sensitivity analyses for different diagnostic subgroups, infertility history remained a strong risk factor. An infertility history was a consistent risk factor for endometriosis in both the operative and population cohorts of the ENDO Study. Additionally, identified risk factors for endometriosis vary based upon cohort selection and diagnostic accuracy. Finally, endometriosis in the population may be more common than recognized.
Diagnosis · Diagnostic Delay
Incidence, prevalence, and trends in endometriosis diagnosis: a United States population-based study from 2006 to 2015
Christ JP et al., 2021 · American journal of obstetrics and gynecology
Accurate estimates of incidence and prevalence of endometriosis among nonselected cohorts are lacking in the United States, and earlier reports have produced varying results. This study aimed to define endometriosis incidence and prevalence in a US population and evaluate factors influencing these estimates over time. A 10-year retrospective cohort study using Kaiser Permanente Washington electronic health records database was completed. The primary analysis included women enrollees aged 16 to 60 years, from January 2006 to December 2015, who had a uterus, were continuously enrolled for at least 2 years before cohort entry and had at least 1 healthcare utilization. Secondary analysis included all women enrollees aged 16 to 60 years during this time. Incident endometriosis was identified using the International Classification of Diseases, Ninth Revision and Tenth Revision, diagnosis codes. Annual incidence rates were age-adjusted by direct standardization to the 2015 study population. Secular trends in incidence overall and by 5-year age group, race and ethnicity, diagnosis modality, and practitioner type were assessed using Poisson regression analyses. Prevalent cases were defined as women enrolled in 2015 and had an endometriosis diagnosis before the end of 2015. The prevalence rates of chronic pelvic pain and dysmenorrhea defined by the International Classification of Diseases, Ninth Revision and Tenth Revision, diagnosis codes in 2006-2015 were estimated. Among 332,056 eligible women who contributed 1,176,329 person-years during the 10-year study period, 2863 incident endometriosis cases were identified for an average incidence of 24.3 cases per 10,000 person-years. In our primary analysis, incidence rates declined over the study interval from a high of 30.2 per 10,000 person-years in 2006 to 17.4 per 10,000 person-years in 2015 and were highest among women aged 36 to 45 years in most years. Incidence rates were similar across race and ethnicity groups. The distribution of the 2863 incident cases by the diagnosis modality was as follows: 45.5% surgical, 5.7% imaging, and 48.8% clinical. Endometriosis incidence rates per 10,000 person-years were similar in women who were surgically and clinically diagnosed and decreased significantly from 2006 to 2015 (surgically diagnosed endometriosis dropped from 13.4 to 7.4 and clinically diagnosed endometriosis dropped from 16.1 to 8.9; P value of <.001 for linear trend over time for each). Incident case distribution by diagnosing provider was as follows: 73.6% obstetrician and gynecologist, 15.7% primary care provider, and 10.7% "other." Incidence of endometriosis diagnosed by an obstetrician and gynecologist and primary care provider decreased over the study interval (P<.001 for linear trend over time for each). Method of diagnosis and provider type did not differ by race and ethnicity. Among 135,162 women who contributed person-time in 2015, 2521 women were diagnosed with endometriosis, a prevalence rate of 1.9%. In our secondary analysis, the frequency of chronic pelvic pain diagnosis increased over the study interval from 3.0% in 2006 to 5.6% in 2015. The incidence rates of endometriosis declined over the 10-year study interval and did so uniformly across age groups, races and ethnicities, and the main diagnosing modalities and providers. Declining rates may reflect a shift in practice patterns in the United States away from the diagnosis of endometriosis both clinically and surgically, rather than favoring more general diagnoses of chronic pelvic pain. The prevalence of endometriosis in 2015 in the United States is in keeping with data from recent studies outside the United States using health record data.
Fertility and Outcomes · Conception After Excision
Adverse pregnancy outcomes associated with endometriosis in Ukraine: results a multicenter study
Salmanov AG et al., 2024 · Wiadomosci lekarskie (Warsaw, Poland : 1960)
To estimate pregnancy outcomes associated with endometriosis in Ukraine. Materials and We performed the multicentre prospective cohort study during the period from January 1st, 2019 to December 31st, 2021. The study included pregnant women aged ≥18 years hospitalized in 17 hospitals from 15 regions of Ukraine. Logistic regression analysis provided odds ratios (OR) with 95% confidence intervals (CI). Of the 27,558 women, 990 (3,6%) reported a diagnosis of endometriosis before pregnancy. In 990 deliveries, women with endometriosis had a higher risk of hypertension in pregnancy (OR 1.2, 95% CI 1.0-1.3), preeclampsia (OR 1.4, 95% CI 1.3-1.5), severe preeclampsia (OR 1.7, 95% CI 1.5-2.3), hemorrhage in pregnancy (OR 2.3, 95% CI 2.0-2.5), placental abruption (OR 2.0, 95% CI 1.7-2.3), placenta previa (OR 3.9, 95% CI 3.5-4.3), premature rupture of membranes (OR 1.7, 95% CI 1.5-1.8), and retained placenta (OR 3.1, 95% CI 1.4-6.6). The neonates had increased risks of preterm birth before 28 weeks (OR 3.1, 95% CI 2.7-3.6), birth before 34 weeks (OR 3.2, 95% CI 2.8-3.6), being small for gestational age (OR 1.5, 95% CI 1.4-1.6), being diagnosed with congenital malformations (OR 1.3, 95% CI 1.3-1.4), and neonatal death (OR 1.8, 95% CI 1.4-2.1). Pregnant women with endometriosis are at elevated risk for serious and important adverse maternal, fetal and neonatal outcomes. The magnitude of these complications calls for more intensive antenatal care of pregnant women with endometriosis.
Epidemiology of complications associated with gynecological laparoscopy procedures in Ukraine: results a multicenter study
Salmanov AG et al., 2024 · Wiadomosci lekarskie (Warsaw, Poland : 1960)
To estimate the frequency of complications during laparoscopic gynecologic surgery for benign diseases in women and identify associated risk factors in Ukraine. Materials and A multicenter, prospective cohort study was performed in gynecological departments from 10 regional hospitals of Ukraine between January 1, 2020, to December 31, 2022. The study included gynecologic laparoscopies for benign diseases in women performed at these hospitals. To identify risk factors and variables associated with complications, crude and adjusted odds ratios were calculated with unconditional logistic regression. Surveillance was performed during 30 days after gynecological laparoscopy procedures. A total of 14,440 laparoscopic surgeries were performed, 2,340 (16.2%) complications cases were observed. Of all complication's cases, 74.9% were detected after hospital discharge. The overall frequency of major complications was 5.04%, and that of minor complications was 11.2%. The most frequently reported complications types were serious bleeding complications (20.6%), intestinal perforation (17.9%), mild anemia (16.7%), severe anemia (transfusion) (16.1%), failed laparoscopy (9.3%), minor bleeding complications (8.3%), postoperative hematoma (6.7%), urinary tract infection (5.6%), and fever (5.0%). The level of technical difficulty and existence of prior abdominal surgery, and obesity were associated with a higher risk of complications associated with gynecological laparoscopy procedures. Results this study suggest a high frequency of complications associated laparoscopic gynecologic surgery in Ukraine. Greater technical difficulty and prior surgery were factors associated with a higher frequency of complications.
Endometriosis › Pathophysiology › Origin Theories · General Gynecology › Infections › Pelvic Inflammatory Disease
Aidyn G Salmanov, Volodymyr V Artyomenko, Olena A Dyndar, Iryna M Lypko, Victor O Rud, Lidiya V Suslikova, Andrey O Semenyuk, Oleksandr V Zabudskyi, Svitlana M Korniyenko, Olga V Gorbunova, Vitalii S Strakhovetskyi, Yuliia V Strakhovetska, Olena O Lytvak, Khrystyna V Zarichanska, Andriy I Chubatyy, Olexandr P Kononets, Mykhailo V Knyhin
A Salmanov, V Artyomenko, O Dyndar, I Lypko, V Rud, L Suslikova, A Semenyuk, O Zabudskyi, S Korniyenko, O Gorbunova, V Strakhovetskyi, Y Strakhovetska, O Lytvak, K Zarichanska, A Chubatyy, O Kononets, M Knyhin
PMID 40847861 40847861 DOI 10.36740/wlek/208988 10.36740/wlek/208988 Salmanov et al. 2025, Salmanov 2025