Gynecological Conditions That Present Obstetrical Risks
Multiple gynecological conditions significantly increase obstetrical risks, including endometriosis, uterine fibroids, polycystic ovary syndrome (PCOS), cervical abnormalities, pelvic inflammatory disease, and gynecological cancers. These conditions require specialized management during pregnancy to minimize maternal and fetal complications.
Endometriosis
Endometriosis significantly increases obstetrical risks, particularly in first pregnancies:
Increased risks include:
Women with endometriosis who underwent gynecological surgery before pregnancy face even higher risks 2
Polycystic Ovary Syndrome (PCOS)
PCOS is associated with significant obstetrical complications:
3-4 fold increased risk of pregnancy-induced hypertension and preeclampsia 3
3-fold increased risk of gestational diabetes 3
2-fold higher chance of premature delivery 3
Risk factors are amplified in multiple gestations with PCOS:
Gynecological Cancers
According to CDC guidelines, certain gynecological cancers present significant obstetrical risks 5:
- Endometrial cancer: Associated with increased risk for adverse health events during pregnancy
- Ovarian cancer: May present obstetrical risks, though specific data is limited
Uterine Abnormalities
Uterine abnormalities can significantly impact pregnancy outcomes:
- Uterine fibroids: Present moderate obstetrical risk (Class 2 condition per CDC guidelines) 5
- Distorted uterine cavity: Presents significant risk (Class 4 condition) 5
- Other anatomical abnormalities: Present moderate risk (Class 2) when not distorting the uterine cavity 5
Pelvic Inflammatory Disease (PID)
PID presents significant obstetrical risks:
- Current PID: High risk condition (Class 4 for initiation) 5
- Past PID without subsequent pregnancy: Moderate risk (Class 2) 5
- Past PID with subsequent pregnancy: Low risk (Class 1) 5
Sexually Transmitted Infections
- Current purulent cervicitis, chlamydial or gonococcal infection: High risk (Class 4 for initiation) 5
- Vaginitis (including Trichomonas vaginalis and bacterial vaginosis): Moderate risk (Class 2) 5
Gestational Trophoblastic Disease
This condition is associated with increased risk for adverse pregnancy events 5:
- Persistently elevated β-hCG levels or malignant disease with intrauterine involvement: High risk (Class 4) 5
- Persistently elevated β-hCG levels without intrauterine involvement: Moderate risk (Class 2) 5
Cervical Abnormalities
- Cervical cancer awaiting treatment: High risk (Class 4 for initiation) 5
- Cervical intraepithelial neoplasia: Moderate risk (Class 2) 5
Clinical Implications and Management
Pre-conception counseling is essential for women with gynecological conditions to understand and mitigate risks
Risk stratification should be performed using validated tools such as the Maternal Severity Index (MSI) and Obstetric Comorbidity Index (OB-CMI) 6
Increased surveillance during pregnancy is warranted for women with gynecological conditions, particularly those with endometriosis, PCOS, or gynecological cancers
Multidisciplinary approach involving maternal-fetal medicine specialists is recommended for women with high-risk gynecological conditions 5
Continuous risk assessment throughout pregnancy and postpartum is critical as approximately one-third of all pregnancy-related deaths occur between 7 and 365 days postpartum 6
Pitfalls to Avoid
Underestimating risks: Women with endometriosis require increased antenatal surveillance due to significantly higher risks of complications 2
Overlooking multiple gestations: In women with PCOS, multiple gestations significantly amplify obstetrical risks; single embryo transfer should be prioritized during fertility treatment 4
Neglecting postpartum follow-up: Continuous risk assessment should extend into the postpartum period 6
Failing to consider obesity as a compounding factor: Obesity further increases obstetrical complications in women with PCOS and multiple gestations 4