Vaginal delivery in women with perianal Crohn's disease: why not?
Irene J. Schaafsma, Froukje J. Hoogenboom, Gerard Dijkstra, Jelmer R. Prins, Marijn C. Visschedijk
Abstract
Pregnant women with active perianal Crohn's disease (CD), have an indication for a caesarean section according to the current ECCO-guidelines. This advice is based on the assumption that vaginal delivery leads to exacerbation of perianal disease and worsening of faecal continence. However, there is no strong evidence to support this. This study aims to examine the effects of delivery method on perianal disease progression and faecal incontinence in women with perianal CD. In this retrospective cohort study, 102 women were selected from the 1000IBD cohort of a tertiary hospital in the Netherlands. All women are >18 years, have perianal CD, and have given birth. Additionally, all women completed a questionnaire. Faecal continence was scored using the Vaizey-score. Using SPSS descriptive analysis and linear regression analysis were performed, p-values <0,05 were considered statistically significant. The caesarean section rate within our cohort was 19,5%. Within the group of women who delivered at least one child vaginally (n=84), 25,5% reported alteration of faecal continence, compared to 18,8% in women who only had caesarean sections (n=18). After a mean follow up of 15 years, the median Vaizey-score within the caesarean section group was 5, compared to 7 in the vaginal delivery group. Within the vaginal delivery group, 13,1% reported perianal disease progression, compared to 22,2% in the caesarean section group. No significant relation between mode of delivery and faecal continence or perianal disease progression was found (B 0,97 [-1,19-3,14] p 0,38). Faecal incontinence and perianal disease progression after vaginal delivery in CD women with active perianal fistula is not significantly increased in this retrospective cohort. This study opens the discussion for more tailored obstetric advice in women with perianal CD.