Impact of Mode of Delivery on Outcomes in Patients with Perianal Crohnʼs Disease

Cheng, Alice G; Oxford, Emily C; Sauk, Jenny; Nguyen, Deanna D.; Yajnik, Vijay; Friedman, Sonia; Ananthakrishnan, Ashwin N.

doi:10.1097/mib.0000000000000093

Cited by 34 publications

(13 citation statements)

References 23 publications

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“…Second, this cohort was not adequately powered to examine specifically the effect of mode of delivery on women with established perianal CD. However a complementary study recently published by our group supports the safety of vaginal delivery in that cohort as well, albeit acknowledging a selection bias in the choice of mode of delivery 35 . Third, we did not have information on the indication for CS (obstetric, provider, or patient preference) or occurrence of complications such as need for episiotomy or perianal tear during vaginal delivery and post-operative complications in the CS group.…”

Section: Discussionmentioning

confidence: 54%

“…from the Netherlands identified no increase in risk of progression to perianal involvement in CD patients without perianal disease prior to pregnancy for vaginal compared with CS delivery (5% vs. 14%, p=NS) 26 . We have recently described that vaginal delivery may be safe in women with perianal disease and not associated with short-term increase in risk of complications, albeit acknowledging a selection bias in women trialing a vaginal birth 35 . We extend the findings of that study to this larger cohort without perianal disease prior to delivery and provide reassuring data that in a wider population of CD, vaginal delivery does not appear associated with an increase in incidence of perianal or other complications.…”

Section: Discussionmentioning

confidence: 99%

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Mode of Childbirth and Long-Term Outcomes in Women with Inflammatory Bowel Diseases

et al. 2014

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Introduction: Inflammatory bowel diseases (IBD; Crohn’s disease (CD), ulcerative colitis (UC)) often affect women in their reproductive years. Few studies have analyzed the impact of mode of child-birth on long-term IBD outcomes. Methods: We used a multi-institutional IBD cohort to identify all women in the reproductive age group with a diagnosis of IBD prior to pregnancy. We identified the occurrence of a new diagnosis code for perianal complications, IBD-related hospitalization and surgery, and initiation of medical therapy after either a vaginal delivery or caesarean section (CS). Cox proportional hazards models adjusting for potential confounders was used to estimate independent effect of mode of child-birth on IBD outcomes. Results: Our cohort included 360 women with IBD (161 CS). Women in the CS group were likely to be older and more likely to have complicated disease behavior prior to pregnancy. During follow-up, there was no difference in the likelihood of IBD-related surgery (multivariate hazard ratio 1.75, 95% confidence interval (CI) 0.40 – 7.75), IBD-related hospitalization (HR 1.39), initiation of immunomodulator therapy (HR 1.45) or anti-TNF therapy (HR 1.11). Among the 133 CD pregnancies with no prior perianal disease, we found no excess risk of subsequent new diagnosis perianal fistulae with vaginal delivery compared to CS (HR 0.19, 95% CI 0.04 – 1.05). Conclusions: Mode of delivery did not influence natural history of IBD. In our cohort, vaginal delivery was not associated with increased risk of subsequent perianal disease in women with CD.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Mode of Childbirth and Long-Term Outcomes in Women with Inflammatory Bowel Diseases

et al. 2014

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“…However, there is a paucity of data to support actual harm from vaginal deliveries in CD women with inactive perianal disease (14). In a retrospective study of women with history of perianal disease, Cheng et al showed there was no difference in worsening of perianal symptoms between those who had vaginal and Cesarean delivery (15). Current guidelines recommend Cesarean delivery for CD only in the presence of active perianal disease, not inactive disease (5).…”

Section: Discussionmentioning

confidence: 99%

Predictors of Cesarean Delivery in Pregnant Women with Inflammatory Bowel Disease

Sharaf

Nguyen

2018

Journal of the Canadian Association of Gastroenterology

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Aim Pregnant women with Crohn’s disease (CD) or ulcerative colitis (UC) are likelier to undergo Cesarean delivery than women without IBD. Active perianal disease is the only IBD-related indication for Cesarean delivery. We sought to identify clinical factors contributing to these high rates. Methods We conducted a retrospective cohort study of 369 pregnant women with IBD who delivered at our institution between 2006 and 2014. We used logistic regression to identify clinical predictors of Cesarean delivery. Results The Cesarean delivery rate among women with CD and UC were 52% and 48%, respectively. Thirty of Cesarean deliveries (54%) in CD and UC patients were performed emergently, respectively. Among those with CD, the strongest predictors of Cesarean delivery were history of perianal disease (adjusted odds ratio [aOR), 13.6; 95% CI: 3.87–47.5) and prior Cesarean delivery (aOR, 22.2; 95% CI: 6.16–80.2). Among women who underwent Cesarean delivery because of perianal disease, only 42% had active perianal symptoms during pregnancy. In UC patients, history of colectomy was a predictor of Cesarean delivery (aOR, 5.08; 95% CI: 1.95–13.2). Cesarean delivery increased the postpartum length of stay by 1.1 days on average for both CD and UC patients, reflecting a 57% and 90% increase over vaginal delivery after adjusting for confounders. Conclusions The decision to perform Cesarean delivery for women with IBD is complex involving IBD-related and obstetric factors and is ideally made by a multidisciplinary team that includes input from a gastroenterologist and obstetrician.

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“…The indication for these deliveries diverges from current guidelines, though the extent of divergence appears consistent with other recent findings of cesarean delivery for IBD. In a recent study by Cheng et al 24 50 (82%) of 61 patients with perianal CD underwent cesarean delivery, though only three were noted to have active perianal disease during pregnancy. This data provides a real-world assessment of adherence to delivery guidelines in IBD.…”

Section: Discussionmentioning

confidence: 95%

Indications for Mode of Delivery in Pregnant Women with Inflammatory Bowel Disease

Burke

Haviland

Hacker

et al. 2017

Inflammatory Bowel Diseases

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Background Reasons for the increased incidence of cesarean delivery among women with inflammatory bowel disease remain unclear. We assessed cesarean delivery incidence and factors influencing mode of delivery in women with inflammatory bowel disease. Methods We performed a 10-year retrospective cohort study of nulliparous women who delivered a singleton infant at our institution. We compared risk for each mode of delivery in women with Crohn's disease and ulcerative colitis to women without inflammatory bowel disease. We assessed mode of delivery indications for patients with inflammatory bowel disease and whether cesarean deliveries were planned. Results The overall incidence of cesarean delivery among women with Crohn's disease (24/59; 40.7%) was similar to women without inflammatory bowel disease (7868/21805; 36.1%) (RR 1.1 [95% CI: 0.83,1.5]; p=0.46), but was increased in the subgroups with active and inactive perianal disease (RR 2.3; p<0.01). Women with ulcerative colitis had a 1.8-fold increased relative risk of cesarean delivery (41/65; 63.1%) (95% CI 1.5, 2.1; p<0.01), with highest incidence in patients with ileal pouch-anal anastomosis. Forty-nine percent of ulcerative colitis and 66.7% of Crohn's disease cesarean deliveries were unplanned, with only one unplanned delivery performed for active inflammatory bowel disease. Most unplanned deliveries were for arrest of descent/dilation and non-reassuring fetal heart tracings. Seventy-five percent of planned cesarean deliveries were for inflammatory bowel disease-related indications. Conclusions Women with ulcerative colitis and perianal Crohn's disease have an increased incidence of cesarean delivery. At least half of cesarean deliveries are unplanned.

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Impact of Mode of Delivery on Outcomes in Patients with Perianal Crohnʼs Disease

Cited by 34 publications

References 23 publications

Mode of Childbirth and Long-Term Outcomes in Women with Inflammatory Bowel Diseases

Mode of Childbirth and Long-Term Outcomes in Women with Inflammatory Bowel Diseases

Predictors of Cesarean Delivery in Pregnant Women with Inflammatory Bowel Disease

Indications for Mode of Delivery in Pregnant Women with Inflammatory Bowel Disease

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