Endometriosis in Pregnancy: A Case Report

Women with endometriosis often present with pelvic pain and are at an increased risk of preterm labor. In this report, we discuss the case of a 27-year-old G2P1 at 29 weeks of gestation who presented to the ED with severe abdominal pain after being seen several times since 24 weeks of gestation in the obstetrics emergency triage with complaints of abdominal pain. Labs showed anemia with an elevated white blood cell (WBC) count and elevated liver function tests (LFTs) and CA-125. Due to intense pain, imaging was unavailable at the time of presentation, but the patient had a new mass the prior week, which was 9 cm in diameter and appeared to be in the uterine cavity. The patient was in preterm labor with advanced cervical dilation with the baby in double footling breech presentation, and hence a C-section was performed demonstrating a left hemorrhagic tubal mass determined to be an endometrioma on pathology. The patient had an uncomplicated postoperative course and was discharged on her third hospital day. Our case report focuses on a unique presentation and the pathophysiology of endometriosis. Endometriosis can present in various ways, leading to a delay in diagnosis and treatment. Endometriosis can create a significant burden on a woman’s health and financial status, and hence it is important to continue to study its complex presentation, in search of more effective, affordable, and non-invasive treatments.