High cesarean section rates are observed in patients with inflammatory bowel disease (IBD), but limited data are available to support this decision.
Dr Arthur Foulon and colleagues conducted a comprehensive review to evaluate the most appropriate mode of delivery in women with IBD according to disease phenotype and activity, as well as surgical history.
The research team searched MEDLINE and international conference abstracts, and included all studies that evaluated digestive outcome after delivery in patients with IBD.
The team screened a total of 41 articles or abstracts, and 18 studies were considered in this review, with sample sizes ranging from 4 to 229 patients and follow-up ranging from 2 months to 8 years.
|Episiotomy did not influence the incidence of perianal Crohn's disease|
|Inflammatory Bowel Diseases|
Pooled cesarean section rates in patients without perianal Crohn's disease, healed perianal Crohn's disease or active perianal Crohn's disease, were 27%, 43%, and 46%, respectively.
Regarding the median rate of new perianal Crohn's disease or recurrence, no increase was observed in patients with vaginal delivery compared to cesarean section, but for patients with an active disease, worsening of symptoms was noted in two-thirds of cases.
The researchers found that episiotomy, perianal tears, and instrumental delivery did not influence the incidence of perianal Crohn's disease.
In patients with ileal pouch anal anastomosis, uncomplicated vaginal delivery seemed to moderately influence pouch function, with no significant difference in terms of overall continence, daytime, or night-time stool frequency, or incontinence.
The team found that these parameters seemed negatively impacted by a complicated vaginal delivery.
Dr Foulon's team concludes, "New long-term data from well-designed studies are needed, but our review suggests that systematic cesarean section in patients suffering from IBD should probably be limited to women at risk of perineal tears and obstetric injuries, with an active perianal Crohn's disease, or with ileal pouch anal anastomosis."