Introduction Management of pregnant patients with inflammatory bowel disease (IBD) can be complex, requiring specialist knowledge and access to multidisciplinary care from Obstetricians, Radiologists and Surgeons. To this end, a combined IBD-Obstetric clinic was started in May 2013. The aim of this study was to identify the benefits of the combined service in improving adherence to guidelines and pregnancy outcomes.
Method Retrospective review of records to obtain patient demographics, medical, drug, surgical and obstetric history, mode of delivery and birth weight over a period of 3 years from May 2013 till May 2016.
Results A total of 95 pregnancies in 89 women (mean age 31, range 19–43) were identified. 39 women had Crohn’s disease, 49 ulcerative colitis and 1 IBD-unclassified. 37 women were on 5ASA, 20 Azathioprine, 5 Infliximab, 4 Adalimumab and 2 on combination Azathioprine-Anti-TNF-Ab. Treatments started or reinstated: 25 prednisolone, 16 5ASA and 30 topical therapy in keeping with its safety profile in current guidelines. No women were started on anti-TNF Ab but two women had an increase in Adalimumab dose. 5/6 women had infliximab till week 25. 93% women were well pre-conception and 49% had no flare during the pregnancy. 31 women had an elective caesarean section (CS), 17 an emergency CS and 7 instrumental deliveries. The commonest indications for elective CS were obstetric or maternal choice and in emergency CS, fetal distress. 8 (10%) deliveries were preterm (32–36 weeks), 2 spontaneous, 6 planned. There were 5 births with fetal growth restriction, 1 stillbirth and 2 cardiac congenital anomalies in this cohort, which is not statistically different (Fisher’s exact test, p=0.54 and 0.77) from a 2016 large Australian population study1. Haemoglobin, platelets, albumin and C-reactive protein were not predictive of preterm delivery or stillbirth. Most women were seen at least three times during the pregnancy, co-ordinating clinic appointments with scans at 20, 28 and 32 weeks, with an average of 100 appointments per year and a rising trend with time. Investigations: 9 women had small bowel ultrasound performed by a single experienced Radiologist, 4 non-gadolinium pelvic/small bowel MRIs and 2 sigmoidoscopies. All 15 investigations aided management decisions.
Conclusion This study shows that an experienced combined IBD-Obstetric service improves adherence to guidelines with outcomes that compare favourably to existing published data of IBD care in pregnant patients.
. Shand AW, et al. BJOG2016;123(11):1862–70.
Disclosure of Interest None Declared
- Inflammatory Bowel Disease
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