TRANSLATIONAL AND CLINICAL MEDICINE - Georgian Medical Journal

Abstract

Background: Endometriosis predominantly as subtle lesions, has been documented soon after menarche and even in pre-menarcheal girls, may have a pathogenesis that differs from retrograde menstruation. It is postulated that progenitor stem cells present in shedding endometrium may have a role in the pathogenesis of early-onset endometriosis through retrograde neonatal uterine bleeding.

Aim: To investigate the impact of the occurrence of vaginal bleeding during newborn first days of life with the present condition of the patient diagnosed with endometriosis /endometrioma / adenomyosis. Also with our study we investigate the real incidence of neonatal uterine bleeding in Tbilisi region. The study is ongoing, but we would like to share our 18 months results.

Methods: To be able to collect as many data as possible in a short time interval multicenter study was started in 19 countries of Europe included Tbilisi, Georgia. Our study is a part of multicenter study https://doi.org/10.1186/ISRCTN60023255.

The frequency of Neonatal uterine bleeding was prospectively evaluated among 4 maternity hospitals, in the town of Tbilisi, Georgia between October 1^st 2016 until April 1^s 2018. Midwifes, nurses and pediatricians following these neonates were informed and participated in the study registering any neonatal uterine bleeding events and informing the study chief investigator (Lela Tandashvili). In addition all neonatal uterine bleeding cases were followed by telephone direct communication with the mothers’ newborns during the 10^th post-partum day for verification of absence or presence of neonatal uterine bleeding.
During the same time period, 192 women age from 17 to 55 visited our clinics with histopathological confirmed diagnosis of endometriosis after laparoscopy, laparotomy or vaginal surgery due to infertility or pelvic pain, consented to participate in a survey study of neonatal uterine bleeding were observed. Only patients that their mothers firmly remembered their daughters as newborns able to report about neonatal uterine bleeding status were included in the study. A structured questionnaire regarding the age, type of conception, family and medicine history, history about endometriosis and adenomyosis, etc were reported in details by both study groups.
Results: During the 18 month of study period 3188 female neonates were examined and followed for their first 10 days of life for neonatal uterine bleeding. Only 43/3188 neonates 1.3% were diagnosed with neonatal uterine bleeding. Out of the 192 patients with endometriosis only 2 had neonatal uterine bleeding 1% as reported by their mothers.   

Conclusion: The incidence of neonatal uterine bleeding in the area of Tbilisi is 1-1.3%. According to our retrospective analysis, vaginal bleeding during newborn first days of life is 1% related with the present condition of the patient diagnosed with endometriosis /endometrioma / adenomyosis.

Keywords: Neonatal uterine bleeding; retrograde menstruation; fetal uterus; pelvic endometriosis.

 

 

Neonatal uterine bleeding; retrograde menstruation; fetal uterus; pelvic endometriosis.

Brosens I, Benagiano G. Is neonatal Uterine bleeding involved in the pathogenesis of endometriosis as a source of stem cells? Fertility Sterility Home 2013 Sep: 100(3):622-3. Doi:10.1016/j. fertnstert.2013.04.046. Epub 2013 May 30.

Kaiser R.,Grässel G. Frequenz und Stärke der uterinen Neugeborenenblutung. [Incidence and intensity of uterine bleeding in the neonate] [article in German]. Geburtshilfe Frauenheilkd 1974; 34: 644-648 Google Scholar

Eskenazi B, Warner ML; Epidemiology of endometriosis, Obstetrics and Gynecology Clinics of North America, 1997, vol. 24 (pg. 235-258); Google Scholar

Meuleman C, Vandenabeele B, Fieuws S, Spiessens C, Timmerman D, D'Hooghe T. High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners, Fertil Steril, 2009, vol. 92 (pg. 68-74) Google Scholar

Maruyama T(1), Yoshimura Y. Stem cell theory for the pathogenesis of endometriosis. Frontiers in bioscience (Elite edition), vol 4, pp. 2854-2863. 2012 Jun 1;4:2754-63.

Signorile P, Baldi F, Rossana B, Bussani R, Viceconte R, Bulzoni P, D’Armiento M, D’Avino A, Baldi A; Embriologic origin of endometriosis: Analysis of 101 human female fetuses; article in Journal of Cellular Physiology 227(4):1653-6 · April 2012 DOI: 10.1002/jcp.22888 · Source: Pubmed

Gargett CE.,Schwab KE.,Brosens JJ.,Puttemans P.,Benagiano G.,Brosens I. Potential role of endometrial stem/progenitor cells in the pathogenesis of early-onset endometriosis. Molecular Human Reproduction 2014; 20: 591-598 Google Scholar

Lévy JM.,Rosenthal R.,Dellenbach P.,Pequenot JP. Crise génitale du nouveau-né. Répercussion de certains facteurs maternels ou gravidiques sur la fréquence des métrorragies néonatales. [Genital crisis in the newborn: repercussion of certain ¬maternal or pregnancy factors on the frequency of neonatal metrorrhagia] [article in French]. Archives Francaises De Pediatrie 1964; 21: 819- Google Scholar

Brosens I.,Brosens J.,Benagiano G. Neonatal uterine bleeding as antecedent of pelvic endometriosis. Human Reprpduction, Volume 28, Issue 11, 1 November 2013, Pages 2893–2897; Google Scholar

Ober WB, Bernstein J. Observations on the endometrium and ovary in the newborn. American Academy of Pediatrics 1955; Vol.16: Issue 4; 445– 460

Marsh EE and Laufer MR; Endometriosis in premenarcheal girls who do not have an associated obstructive anomaly. Fertility Sterility Home 2005 Mar;83(3):758-60.

Sampson J; Peritoneal endometriosis due to the menstrual dissemination of endometrial tissue into the peritoneal cavity; American Journal of Obstetrics and Gynecology 1927 Volume 14, Issue 4, Pages 422–469;

I. Brosens S. Gordts G. Benagiano; Endometriosis in adolescents is a hidden, progressive and severe disease that deserves attention, not just compassion;

Human Reproduction, Volume 28, Issue 8, 1 August 2013, Pages 2026–2031

AD Ebert, N Fuhr, M David, L Schneppel, Papadopoulos T- Histological confirmation of endometriosis in a 9-year-old girl suffering from unexplained cyclic pelvic pain since her eighth year of life. Gynecologic and Obstetric investigation Vol 67, #3, 2009- karger.com;

Gogacz M, Sarzynski M, Napierala R, Semczuk A; Ovarian Endometrioma in an 11-Year-old Girl before Menarche: A case Study with Literature Review; Journal of pediatrics and adolescent gynecology 25(1):e5-e7 · November 2011

Yang Y; Wang Y; Yang J; Wang S, Lang J; Adolescent Endometriosis in China: A Retrospective Analysis of 63 cases; Journal of Pediatrics and Adolescent Gynecology, Volume 25, Issue 5, October 2012, Pages 295-299;

J.E.A Sampson; Peritoneal Endometriosis due to the menstrual dissemination of endometrial tissue into the peritoneal cavity; Article in American Journal of Obstetrics and Gynecology 14(4):93-94 · December 1927