Increased risk of postpartum hemorrhage in women with endometriosis and adenomyosis: a prospective cohort study.

Introduction: A growing body of evidence suggests that women with endometriosis and adenomyosis are at an increased risk of complications during pregnancy and childbirth. Many of these complications are associated with increased blood loss. This study aims to evaluate and quantify the risk of postpartum hemorrhage in women with these conditions. Methods: We conducted a prospective cohort study of women with endometriosis and adenomyosis, analyzing their peripartal blood loss. Matching was performed for age and mode of conception. We defined postpartum hemorrhage as blood loss of ≥1000 mL, regardless of mode of delivery, according to the ACOG definition. Results: In our study, we examined 82 women with endometriosis and adenomyosis and 82 women without. A total of 11 women in the study group experienced postpartum hemorrhage, which is significantly higher than the rate in the control group (13% vs 1%). The unadjusted odds ratio for postpartum hemorrhage in the EM group was 8.74 (CI:2.01-82.00). The p-value was 0.002. In the adjusted analysis, participants with EM had a significantly increased risk of PPH compared to those without EM (OR:7.56, 95% CI:1.39-83.70, p=0.018), while gravidity and parity had no significant effect on the risk of PPH in our cohort. Conclusion: Our study found that women with endometriosis and adenomyosis were significantly more likely to experience postpartum hemorrhage than women without these conditions. These findings should be interpreted with caution, given the small sample size and wide confidence intervals. However, they suggest that women with endometriosis and adenomyosis may benefit from giving birth at hospitals with experience in managing postpartum hemorrhage.