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Crohn's perianal disease influences delivery methods in pregnancy

The latest issue of the Diseases of the Colon & Rectum evaluates the impact of perianal disease on delivery methods and complications in pregnant patients.

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The optimal delivery method in patients with Crohn’s disease is unknown, and there is no large-scale evidence on which to base decisions.

Dr Quinton Hatch and colleagues compared delivery methods and outcomes in patients with and without Crohn’s disease.

The Nationwide Inpatient Sample and International Classification of Diseases, Ninth Revision codes were used to identify childbirth deliveries.

Patients were stratified by the presence or absence of Crohn’s disease and perianal disease.

The research team used a large population-cohort database for the analysis.

Patients with Crohn’s disease have higher rates of cesarean delivery
Diseases of the Colon & Rectum

The researchers' primary outcomes measured were cesarean delivery and perineal lacerations.

Of 6,794,787 pregnant women who delivered, 2882 had a diagnosis of Crohn’s disease.

Rates of cesarean delivery were higher in patients who had Crohn’s disease with and without perianal disease in comparison with patients who did not have Crohn’s disease with and without perianal disease.

The team noted that rates of 4th degree perineal lacerations were similar between patients who had or did not have Crohn’s disease without perianal disease, but these rates increased significantly in patients with perianal disease.

On multivariate analysis, the team found that perianal disease and smoking were independently associated with higher rates of 4th degree laceration.

Crohn’s disease was not independently associated with 4th degree laceration.

Dr Hatch's team concludes, "Patients with Crohn’s disease have higher rates of cesarean delivery."

"Perianal disease predicts severe perineal laceration independent of the presence of Crohn’s disease."

"In the absence of perianal disease, the method of delivery in women with Crohn’s disease should be predicated on obstetric indication."

Dis Colon Rectum 2014: 57(2): 174–178
06 February 2014

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