Defining the Most Appropriate Delivery Mode in Women with Inflammatory Bowel Disease

Abstract

New long-term data from well-designed studies are needed, but our review suggests that systematic CS in patients suffering from IBD should probably be limited to women at risk of perineal tears and obstetric injuries, with an active PCD, or with ileal pouch anal anastomosis.

Impact of introducing specific measures to reduce the frequency of cesarean delivery for non‐obstetric indications

“…Uncomplicated vaginal delivery does not worsen the course of IBD, even in the case of perianal injury. However, such patients should be considered on an individual basis, and active disease in the perianal area remains a contraindication for vaginal delivery because of potential adverse events that could affect continence . In the present study, there were 22 cesarean deliveries for women with IBD in the first period, but none in the second period owing to the stricter assessment criteria.…”

Anal incontinence after vaginal delivery or cesarean section

“…Fecal urgency is defined as having difficulty deferring a sudden or compelling desire to defecate. 5,14,[16][17][18][19][20] The role of planned CS in order to prevent OASIS, AI, and the potential impact of delivery on women's future health remains unclear 1,7,21 A Cochrane Review concluded that planned CS showed no benefit in the prevention of AI in postpartum women. 2,12,13 Furthermore, other studies have shown that AI, in particular, may have a devastating impact on women's social, emotional, and physical activity as well as their quality of life.…”

“…14,15 AI is associated with increasing age, obesity, pregnancy, instrumental VD, and obstetric anal sphincter injury (OASIS). 5,14,[16][17][18][19][20] The role of planned CS in order to prevent OASIS, AI, and the potential impact of delivery on women's future health remains unclear 1,7,21 A Cochrane Review concluded that planned CS showed no benefit in the prevention of AI in postpartum women. 7 The aim of this study was to explore whether women who only had delivered vaginally were at greater risk of developing AI than women who had undergone only cesarean sections or women who had never experienced childbirth.…”

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

“…A recent systematic review reached the conclusion that uncomplicated vaginal delivery only moderately influenced pouch function, with no significant difference in overall continence or stool frequency. Nevertheless, function was significantly worsened in a complicated delivery, perhaps still justifying an elective caesarean in these patients [847]. Regarding patients who have an ileorectal anastomosis, there is clearly intact rectal function and patients may not be so 'borderline incontinent'.…”