Millions of women with a painful womb condition should be monitored much more closely in pregnancy because they are at a higher risk of losing their babies, doctors said last night.
They spoke out after a major study showed that endometriosis, which affects around one in ten women, raises the odds of a host of complications in pregnancy. These range from miscarriages and premature birth to potentially deadly haemorrhages. But watching these women more closely could reduce the danger – and save their life and that of their baby.
Endometriosis occurs when cells normally found in the womb lining attach themselves to other parts of the pelvic area, causing scarring, inflammation and pain. It was known to cause fertility problems, but it had been thought that once a woman did conceive, the condition was unlikely to put her pregnancy at risk. However, the issue had not been thoroughly researched. Now, Aberdeen University researchers have trawled through 30 years of medical records in Scotland, allowing them to compare pregnancies of women who have endometriosis with those of women without the condition.
CERVICAL CANCER ALERT FOR OVER-50S
Women over 50 are putting their lives at risk by failing to go for smear tests, researchers warn. Many wrongly believe they are immune to cervical cancer as they think it is only caused by casual sex. But experts say the virus that causes the illness can lie dormant for 20 years and it can then be another ten to 15 years before tumours appear.
There are 3,100 new cases of cervical cancer in the UK a year, of which a third are in women over 50. Older women are much more likely to be diagnosed with late-stage tumours, which are inoperable, and death rates are twice as high. Scientists say this is because they fail to attend smear tests, which pick up the first signs of the cancer.
A report by the charity Jo’s Cervical Cancer Trust shows that 81.6 per cent of 50 to 54-year-olds attended a test, dropping to 74.8 per cent of 55 to 59-year-olds and just 73.2 per cent of 60 to 64-year-olds. Women over 55 put off appointments by an average of four years.
The analysis of more than 15,000 pregnant women showed that those with endometriosis were 76 per cent more likely to miscarry. They also had almost triple the chance of suffering an ectopic pregnancy – when the embryo implants outside the womb and the baby is lost.
Women with endometriosis also have a higher risk of complications later in pregnancy such as giving birth prematurely and haemorrhaging, which can be fatal, the European Society of Human Reproduction and Embryology’s annual conference in Lisbon heard.
It is thought that the complications happen because endometriosis damages the development of the placenta – the lifeline between mother and unborn child. Doctors suggested women with endometriosis should give birth in hospitals with specialist neonatal units so that expert help is on hand.
Researcher Lucky Saraswat, a consultant gynaecologist at Aberdeen Royal Infirmary, said that miscarriages and ectopic pregnancies sadly can’t be prevented – so in these cases the baby cannot be saved.
But if doctors know that women with endometriosis are more at risk, they can monitor them more closely and admit them to a specialist unit at the first sign of trouble – limiting the dangers to the mother. Catching a haemorrhage early can save the life of both the mother and child. Dr Saraswat said: ‘These findings should be used to counsel women with endometriosis and inform them.
‘At the moment, once they are diagnosed with endometriosis, we talk about infertility but we do not talk about what happens once they get pregnant.
‘These finds can also be taken into account when planning antenatal care for these women.’
‘And often the person who waited until 39 to try is a successful career woman, who passed her school exams, went to university, got a good job and climbed up the career ladder and suddenly she can’t have something that everyone else can.’
As many as one in six couples suffers infertility. Almost 40,000 British women have fertility treatment each year, paying up to $15,000 per course, with 12,500 babies born with the help of IVF. Several fertility blood tests already exist, including one developed by Professor Ledger.
They typically use hormone levels to gauge a woman’s ‘ovarian reserve’ – the number of healthy eggs she has left. But critics question how well they work and fear a ‘good’ result could lull women into a false sense of security. Other doctors argue schoolchildren should be taught about fertility during sex education classes. Mark Hamilton, former chairman of the British Fertility Society, said there was ‘widespread misapprehension’ about the success rate of IVF. By the time a woman is in her mid 40s, it can be as low as 5 per cent.
Dr Hamilton, of Aberdeen Maternity Hospital, said: ‘Sexual health messages focus entirely on the avoidance of sex but this should be coupled with promotion of fertility awareness.
‘There is a patchy understanding about fertility among the general public, even among those who are well-read and highly educated.’
Tony Rutherford, the present chair of the BFS, said: ‘If a woman leaves it late – by which I mean 36 – she is taking a gamble.
‘There is a public health duty for us to ensure that men and women are informed about their fertility potential. At the moment, that’s not the case.’
By Fiona Macrae, The Daily Mail