Perineal endometriosis after delivery: causes of development, treatment, prevention

Objective. To reduce the risk of perineal endometriosis after delivery, as well as the recurrence rate of this disease by developing diagnostic and treatment algorithms. Material and methods. A retrospective study of 40 patients with perineal endometriosis who underwent surgical treatment in the department of operative gynecology with oncogynecology and day hospital of the Moscow Regional Research Institute of Obstetrics and Gynecology named after Academician V.I. Krasnopolsky (MONIIAG) in the period from 2015 to 2023 (group 1) was conducted. In addition, 25 patients without perineal endometriosis with physiologic course of labor (2nd additional clinical group) were examined. Results. Risk factors for the development of perineal endometriosis were identified. Diagnosis of endometrioid infiltrates, as a rule, was late, which is associated with the late appearance of clinical signs and late referral to a gynecologist. Ultrasound examination allows you to determine the size, localization and structure of the infiltrate. In the presence of multiple foci of different sizes, especially recurrent, MRI is preferable. Treatment of perineal endometriosis is surgical. Conclusion. Perineal endometriosis after delivery is a delayed complication. Thorough diagnostics based on instrumental methods of investigation allows to optimize surgical treatment tactics. Hormonal therapy of perineal endometrioid infiltrates at pre- and postoperative stages does not lead to clinically significant changes in the course of the disease, only careful observance of the technology of surgical removal of masses can reduce the risk of disease recurrence.