Placenta previa and placental abruption after assisted reproductive technology in patients with endometriosis: a systematic review and meta-analysis
Recent evidence suggests that assisted reproductive technology (ART) increases the risk of adverse pregnancy outcomes, including placental disorders. Similarly, endometriosis resulted detrimental on placenta previa. However, up to 50% of women with endometriosis suffer from infertility, thus requiring ART. The aim of our metanalysis is to compare women with and without endometriosis undergoing ART in terms of placenta disorders events, to establish if ART itself or endometriosis, as an indication to ART, increases the risk of placenta previa.
Literature searches were conducted in January 2018 using electronic databases (PubMed, Medline, Scopus, Embase, Science Direct, and the Cochrane Library Scopus). Series comparing pregnancy outcome after ART in women with and without endometriosis were screened and data on placenta previa and placental abruption were extracted.
Five retrospective case–control studies met the inclusion criteria. The meta-analysis revealed that endometriosis is associated with an increased risk of placenta previa in pregnancies achieved through ART (OR 2.96 (95% CI 1.25–7.03); p = 0.01, I2 =69%, random-effect model). No differences in placental abruption incidence were found (OR 0.44 (95% CI 0.10–1.87); p = 0.26, I2 = 0%, fixed-effect model).
Patients with endometriosis undergoing ART may have additional risk of placenta previa. Despite the inability to determine if endometriosis alone or endometriosis plus ART increase the risk, physicians should be aware of the potential additional risk that endometriosis patients undergoing ART harbor.
KeywordsPlacental abruption Placenta previa Assisted reproduction Endometriosis Adverse pregnancy outcome
MLG was responsible for the conceptualization, literature search, data extraction, and statistical analysis. The paper was equally drafted by MLG, KN, and KT. MM and AP performed the final revision.
Compliance with ethical standards
Conflict of interest
The authors declare to have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 3.Qin JB, Sheng XQ, Wang H et al (2017) Worldwide prevalence of adverse pregnancy outcomes associated with in vitro fertilization/intracytoplasmic sperm injection among multiple births: a systematic review and meta-analysis based on cohort studies. Arch Gynecol Obstet 295:577–597CrossRefPubMedGoogle Scholar
- 4.Karami M, Jenabi E, Fereidooni B et al (2017) The association of placenta previa and assisted reproductive techniques: a meta-analysis. J Matern Fetal Neonatal Med 6:1–8Google Scholar
- 33.Pérez-López FR, Villagrasa-Boli P, Muñoz-Olarte M et al (2018) Association between endometriosis and preterm birth in women with spontaneous conception or using assisted reproductive technology: a systematic review and meta-analysis of cohort studies. Reprod Sci 25:311–319CrossRefPubMedGoogle Scholar
- 46.Song F, Eastwood AJ, Gilbody S et al (2000) Publication and related biases. Health Technol Assess 4:1–115Google Scholar