Pouch function and gastrointestinal complications during pregnancy after ileal pouch-anal anastomosis

Abstract

Pregnancy after IPAA is overall safe, associated with limited complications and no significant alteration in pouch function. Vaginal delivery appears as safe as cesarean section for most women.

The Toronto Consensus Statements for the Management of Inflammatory Bowel Disease in Pregnancy

“…Several studies of women who underwent IPAA found no increased rates of adverse pregnancy outcomes 189 and no change in pouch function after vaginal delivery. [189][190][191][192][193][194] One survey reported that 17% of women had some degree of permanent deterioration of pouch function after delivery, but this was not related to method of delivery. 195 Although several studies of pregnancies after IPAA have shown vaginal delivery to be as safe as cesarean delivery in terms of pouch function, 193,194,196 physiological measurements and imaging studies suggest that there is a higher risk of sphincter injury with vaginal than cesarean delivery.…”

“…196 Data on the risk of fecal incontinence in pregnant women with IPAA are conflicting. 193,195,197 One study reported that women with IPAA had increased stool frequency and fecal incontinence during pregnancy, 195 whereas others found no association during 193 or after pregnancy. 197 A cohort study found that rates of incontinence were not significantly affected by mode of delivery.…”

“…197 A cohort study found that rates of incontinence were not significantly affected by mode of delivery. 193 These studies were small and many were not controlled; thus, the true rate of sphincter injury and the long-term risk of incontinence after vaginal delivery currently remain unclear. As is the case in women without IPAA, the risk of fecal incontinence increases with age, and the effects of mode of delivery may not be apparent in the short-term.…”

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

“…Small bowel obstruction is a rare complication in women with an IPAA after cesarean delivery. 86,100,101…”

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

“…Several studies, however, have yielded conflicting results regarding these outcomes 14, 17-20 . The presence of active perianal disease is also of concern in vaginal delivery, as a vaginal trauma or laceration at the time of delivery may hypothetically lead to progressive perianal symptoms or non-healing fistula in a patient with active perianal CD.…”