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

Abstract

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.

Inflammatory Bowel Disease in Pregnancy Clinical Care Pathway: A Report From the American Gastroenterological Association IBD Parenthood Project Working Group

“…In pregnancy complicated by IBD, the mode of deliverycesarean vs vaginal delivery-should focus on usual obstetric indications (Figure 4). 15,82,83 A patient may undergo vaginal delivery in most presentations of IBD, unless there is active perineal disease present around the time of delivery or unique patient circumstances present. 83,84 Vaginal delivery has not been demonstrated to influence risk for development of IBD in the offspring.…”

Inflammatory bowel disease position statement of the Italian Society of Colorectal Surgery (SICCR): ulcerative colitis

“…In a retrospective series from the USA analyzing the percentage of cesarean sections in women with IBD, all IPAA patients had a cesarean delivery (ten patients out of a total of 65 UC patients) [204]. Total colectomy with ileorectal anastomosis (IRA) is a relatively simple procedure as compared with IPAA, with low morbidity (8-28%) [205].…”

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease

“…The paper was produced through combined systematic literature review and discussions among the expert group chaired by the senior author. These findings are almost universal in each of the studies that have examined this association [831,836,[838][839][840][841][842][843][844].…”

“…The most recent study is a 10‐year retrospective single‐centre cohort study comparing 59 patients with Crohn's and 65 patients with ulcerative colitis with 21 805 women without IBD. They found the likelihood of caesarean section to be the same as in the general population for Crohn's but was double the general population value in the ulcerative colitis group, with the highest incidence being in those with an IPAA .…”