Doppler ultrasound assessment in the Management of endometriosis among pregnant women in low-resource settings

Abstract

Background: Endometriosis affects roughly one in ten women of reproductive age, and many affected women subsequently conceive, carrying the disease into pregnancy, where it complicates adnexal mass assessment and obstetric risk stratification.

Objective: This review synthesizes evidence on Doppler ultrasound assessment of endometriosis in pregnant women, covering decidualized-endometrioma characterization, obstetric Doppler surveillance for endometriosis-associated complications, and feasibility in low-resource settings.

Methods: We conducted a narrative synthesis of consensus terminology statements, diagnostic-accuracy reviews, cohort studies of obstetric outcomes, and implementation studies of point-of-care obstetric ultrasound in low- and middle-income countries.

Findings: Doppler characterization distinguishes decidualized endometriomas from suspicious masses in pregnancy; endometriosis carries a moderate increase in preterm birth, placenta previa, and hypertensive complications already surveilled by uterine and umbilical artery Doppler; and task-shifted point-of-care ultrasound programs show these techniques can be delivered by non-specialist operators in resource-limited settings.

Conclusions: A combined Doppler pathway integrating adnexal characterization with obstetric surveillance is feasible within existing low-resource delivery models, though it has not been prospectively evaluated as an integrated protocol and remains constrained by supervision gaps documented across implementation programs.