Assisted Reproduction · Safety and Risks
Abstract
Aim
To evaluate the association between adverse pregnancy outcome, assisted reproductive technology (ART) and a previous diagnosis of endometriosis in Ukraine.
Materials and Methods
We conducted a multicentre retrospective cohort study was based on infertility surveillance data among women reproductive age from January 1st, 2017 to December 31st, 2021 in Ukraine. The patients from 10 Ukrainian regions who achieved singleton pregnancy by ART were included in this study. Linked hospital, pregnancy/birth and mortality data were used. Logistic regression analysis was performed to calculate odds ratios (OR) and 95 % confidence interval (CI) for the rates of adverse pregnancy outcomes.
Results
During study period within the cohort of 11,271 singleton births, 94 women with endometriosis diagnosed before birth delivered 102 infants. Compared with women without endometriosis, women with endometriosis had higher risks of preterm birth [adjusted odds ratio 1.33, 95% confidence interval (CI), 1.23-1.44]. 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.
Conclusions
Endometriosis and ART use are both independently associated with increased risk of preterm birth, antepartum haemorrhage, placenta praevia and planned birth. These findings are clinically relevant to obstetricians for distinguishing high- and low-risk pregnancies. Pregnant women with endometriosis require increased antenatal surveillance.
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.
Pathophysiology · Origin Theories
Obstetric and gynecological surgical procedures, and surgical site infections as risk for the development of endometriosis: a multicenter study
Salmanov AG et al., 2025 · Wiadomosci lekarskie (Warsaw, Poland : 1960)
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 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. 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). Obstetric and gynecological surgical injury, and the inflammation resulting from SSIs may play a role in developing endometriosis.
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.
Related research
Safety and Risks · Maternal Complications
Assisted reproductive technology and the risk of pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies: a meta-analysis of cohort studies
Qin J et al., 2016 · Fertility and sterility
To determine whether there are any increases in pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies after assisted reproductive technology (ART) compared with those conceived naturally. Meta-analysis. University-affiliated teaching hospital. PATIENT(S): Singleton pregnancies conceived with ART and naturally. INTERVENTION(S): PubMed, Google Scholar, Cochrane Libraries and Chinese database were searched through March 2015 to identify studies that met pre-stated inclusion criteria. Either a fixed- or a random-effects model was used to calculate the overall combined risk estimates. Subgroup analysis was performed to explore potential heterogeneity moderators. MAIN OUTCOME MEASURE(S): Pregnancy-related complications and adverse pregnancy outcomes. RESULT(S): Fifty cohort studies comprising 161,370 ART and 2,280,241 spontaneously conceived singleton pregnancies were identified. The ART singleton pregnancies had a significantly increased risk of pregnancy-induced hypertension (relative risk [RR] 1.30, 95% confidence interval [CI] 1.04-1.62; I(2) = 79%), gestational diabetes mellitus (RR 1.31, 95% CI 1.13-1.53; I(2) = 6%), placenta previa (RR 3.71, 95% CI 2.67-5.16; I(2) = 72%), placental abruption (RR 1.83, 95% CI 1.49-2.24; I(2) = 22%), antepartum hemorrhage (RR 2.11, 95% CI 1.86-2.38; I(2) = 47%), postpartum hemorrhage (RR 1.29, 95% CI 1.06-1.57; I(2) = 65%), polyhydramnios (RR 1.74, 95% CI 1.24-2.45; I(2) = 0%), oligohydramnios (RR 2.14, 95% CI 1.53-3.01; I(2) = 0%), cesarean sections (RR 1.58, 95% CI 1.48-1.70; I(2) = 92%), preterm birth (RR 1.71, 95% CI 1.59-1.83; I(2)=80%), very preterm birth (RR 2.12, 95% CI 1.73-2.59; I(2) = 90%), low birth weight (RR 1.61, 95% CI 1.49-1.75; I(2) = 80%), very low birth weight (RR 2.12, 95% CI 1.84-2.43; I(2) = 67%), small for gestational age (RR 1.35, 95% CI 1.20-1.52; I(2) = 82%), perinatal mortality (RR 1.64, 95% CI 1.41-1.90; I(2)=45%), and congenital malformation (RR 1.37, 95% CI 1.29-1.45; I(2)=41%). Relevant heterogeneity moderators have been identified by subgroup analysis. Sensitivity analysis yielded consistent results. No evidence of publication bias was observed. CONCLUSION(S): The ART singleton pregnancies are associated with higher risks of adverse obstetric outcomes. Obstetricians should manage these pregnancies as high risk.
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.
Fertility and Outcomes · Conception After Excision
Endometriosis diagnosis, staging and typology and adverse pregnancy outcome history
Schliep KC et al., 2022 · Paediatr Perinat Epidemiol · Free full text on PubMed Central
Women with endometriosis may have an increased risk of adverse pregnancy outcomes. Research has focused on infertility clinic populations limiting generalisability. Few studies report differences by endometriosis severity. We investigated the relationships between endometriosis diagnosis, staging and typology and pregnancy outcomes among an operative and population-based sample of women. Menstruating women ages 18-44 years enrolled in the ENDO Study (2007-2009), including the operative cohort: 316 gravid women undergoing laparoscopy/laparotomy at surgical centres in Utah and California; and the population cohort: 76 gravid women from the surgical centres' geographic catchment areas. Pregnancy outcomes were ascertained by questionnaire and included all pregnancies prior to study enrolment. Endometriosis was diagnosed via surgical visualisation in the operative cohort and pelvic magnetic resonance imaging in the population cohort. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) were estimated using generalised linear mixed models for pregnancy outcomes, adjusting for women's age at study enrolment and at pregnancy, surgical site, body mass index and lifestyle factors. Women in the operative cohort with visualised endometriosis (n = 109, 34%) had a lower prevalence of live births, aPR 0.94 (95% CI 0.85, 1.03) and a higher prevalence of miscarriages, aPR 1.48 (95% CI 1.23, 1.77) compared with women without endometriosis. The direction and magnitude of estimates were similar in the population cohort. Women with deep endometriosis were 2.98-fold more likely (95% CI 1.12, 7.95) to report a miscarriage compared with women without endometriosis after adjusting for women's age at study enrolment and at pregnancy, surgical site and body mass index. No differences were seen between endometriosis staging and pregnancy outcomes. While there was no difference in number of pregnancies among women with and without endometriosis in a population-based sample, pregnancy loss was more common among women with endometriosis, notably among those with deep endometriosis.
Fertility and Outcomes · Conception After Excision
Endometriosis and obstetrics complications: a systematic review and meta-analysis
Zullo F et al., 2017 · Fertility and sterility
To evaluate the effect of endometriosis on pregnancy outcomes. Systematic review and meta-analysis. Not applicable. PATIENT(S): Women with or without endometriosis. INTERVENTION(S): Electronic databases searched from their inception until February 2017 with no limit for language and with all cohort studies reporting the incidence of obstetric complications in women with a diagnosis of endometriosis compared with a control group (women without a diagnosis of endometriosis) included. MEAN OUTCOME MEASURE(S): Primary outcome of incidence of preterm birth at <37 weeks with meta-analysis performed using the random effects model of DerSimonian and Laird to produce an odds ratio (OR) with 95% confidence interval (CI). RESULT(S): Twenty-four studies were analyzed comprising 1,924,114 women. In most of them, the diagnosis of endometriosis was made histologically after surgery. Women with endometriosis had a statistically significantly higher risk of preterm birth (OR 1.63; 95% CI, 1.32-2.01), miscarriage (OR 1.75; 95% CI, 1.29-2.37), placenta previa (OR 3.03; 95% CI, 1.50-6.13), small for gestational age (OR 1.27; 95% CI, 1.03-1.57), and cesarean delivery (OR 1.57; 95% CI, 1.39-1.78) compared with the healthy controls. No differences were found in the incidence of gestational hypertension and preeclampsia. CONCLUSION(S): Women with endometriosis have a statistically significantly higher risk of preterm birth, miscarriage, placenta previa, small for gestational age infants, and cesarean delivery.
Assisted Reproduction › Safety and Risks › Neonatal and Birth Outcomes · Birth and Delivery › Birth Outcomes › Maternal Morbidity · Endometriosis › Fertility and Outcomes › Conception After Excision
Aidyn G Salmanov, Volodymyr V Artyomenko, Victor O Rud, Olena A Dyndar, Oleksandra Z Dymarska, Svitlana M Korniyenko, Orusia A Kovalyshyn, Anastasia S Padchenko, Vitalii S Strakhovetskyi
A Salmanov, V Artyomenko, V Rud, O Dyndar, O Dymarska, S Korniyenko, O Kovalyshyn, A Padchenko, V Strakhovetskyi
PMID 39241126 39241126 DOI 10.36740/wlek202407101 10.36740/wlek202407101 Salmanov et al. 2024, Salmanov 2024