Perianal Crohn's disease and pregnancy: Role of the mode of delivery

OBJECTIVE: Elective cesarean section (CS) is a standard recommendation for pregnant women with perianal Crohn's disease. In this study we examined the mode of delivery for pregnant women with Crohn's disease and assessed the relationship between perianal disease activity and delivery mode. METHODS: The University of Manitoba's inflammatory Bowel Disease Database, a population-based database, was interfaced with a provincial birth database to compare the mode of delivery for women with Crohn's disease and ulcerative colitis to that of the general population for the years 1985-1995. To describe clinical issues related to perianal Crohn's disease in relation to mode of delivery, data were obtained from a subset of women with Crohn's disease who had given birth between 1985 and 1995 using a standardized questionnaire. Data regarding Crohn's disease and birth history were verified through chart review (93.8%) and corroboration with the personal physician (87.5%). RESULTS: The total and (elective) CS rates were higher for Crohn's disease 20.9% (9.0%), and for UC 20.8% (9.3%) than the general population 15% (5.4%) (p < 0.01 for each). Among primiparous women, patients with Crohn's disease and UC were also significantly more likely to have CS than the general population. In the target group of 281 women, 52 had births in the years in question and were contactable. There were 54 vaginal births and 10 sections. Fifteen of 54 vaginal births were predated by perianal disease; 4 of 15 reported active perianal disease at birth; and all reported worsening of perianal symptoms postpartum. Those with inactive perianal disease (n = 11) had no relapse of perianal disease in I yr of follow-up postpartum. Of 39 vaginal deliveries with no known perianal disease, only 1 ultimately developed perianal disease within 1 yr of postpartum follow-up. CONCLUSIONS: Women with inflammatory bowel disease undergo CS more often compared to the general population. For those with either no history of perianal disease or inactive perianal disease at birth, the risk of perianal disease relapse is very low and does not justify CS. Active perianal disease at time of delivery is on indication for CS. (C) 1999 by Am. Cell. of Gastroenterology.