Neonatal Uterine Bleeding as a precursors in adult endometriosis (18 months of experience)

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.