Bean, Elisabeth Mary Ruth; (2024) Ultrasound studies of the natural history of endometriosis. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

In this thesis, I have provided original evidence about the natural history of endometriosis, derived from a series of ultrasound studies. The inter-and intra-observer variability of ultrasound for the detection and measurement of endometriotic lesions was assessed in 50 consecutive women and provides the basis for which the remaining studies were conducted and results analysed. The interobserver agreement was good to excellent and the intraobserver agreement was excellent. Transvaginal ultrasound was used to observe morphological changes that precede the development of deep endometriosis in women with clinically significant haemoperitoneum that was managed expectantly. Transvaginal ultrasound was used to observe the natural history of deep endometriosis and endometrioma in women who managed their condition expectantly. There was evidence of disease progression in 37% of women with nodules and 22% with endometrioma. Transvaginal ultrasound was used to assess the prevalence of endometriosis in 1341 women in early pregnancy. The prevalence was estimated to be 4.9%, with ethnicity, subfertility, congenital uterine anomalies and fibroids all being associated with the presence of endometriosis. Decidualisation was observed in 33.3% of women with endometrioma and 31.6% with deep nodules. Transvaginal ultrasound was used to observe the natural history of endometriosis in 65 women during pregnancy. For women with endometrioma, 85.3% experienced regression and 5.9% experienced growth. For women with nodules, 84.3% experienced regression and 3.9% experienced growth. Decidualisation was observed in 50.0% of women with endometrioma and 49.0% of women with nodules. Transvaginal ultrasound was used to screen for endometriosis in 503 pregnant women with a normal pregnancy. Endometriosis was not significantly associated with increased odds of preterm delivery <37 week’s gestation but was associated with increased odds of postpartum haemorrhage during Caesarean section (aOR 3.64 95%CI 2.07–6.35;P<0.001) and their newborn babies being admitted to the neonatal unit (aOR 3.24, 95%CI 1.08–9.73; P = 0.036).

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