Inflammatory bowel disease during pregnancy and childbirth


Authors: K. Závorová
Authors‘ workplace: Gynekologicko-porodnické oddělení Nemocnice Hořovice, primář oddělení MUDr. A. Klán
Published in: Čes. Gynek.2017, 82, č. 2 s. 108-116

Overview

Objective:
The aim is to give basic information about inflammatory bowel disease (IBD) during pregnancy, to highlight the importance of treatment in pregnancy and also show our own experience with the issue.

Design:
Original work – a retrospective study.

Setting:
Department of Obstetrics and Gynecology, Hospital Hořovice.

Results:
We provide basic overview information about inheritance, fertility, mutual influence of IBD and pregnancy therapy in pregnancy and childbirth options for patients with IBD. We present also the results of the group of 17 patients with varying degrees of disability IBD (including patients after previous surgeries – bowel resection, hemicolectomy, ileostomy or with a pouch) that gave birth to our workplace.

Conclusion:
A crucial factor for good results is the degree of inflammation at the time of conception and during pregnancy. If the disease is inactive and nutrition of the diseased sufficient, there is no decrease in fertility, course of pregnancy is seamless, there is no greater risk of deterioration of disease in pregnancy and pregnancy do not differ from the normal population. The opposite situation occurs if there is a pregnancy at the time of disease activity. Then up to 75% pregnancy courses with big problems, fertility is declining, inflammation is also worsening and the risk of exacerbations increases during pregnancy, which aggravates the course of pregnancy and childbirth and has a negative effect on the fetus. Pregnancy is therefore necessary to plan for a longer period of disease stabilization and continue chronic medication and not discontinue drugs for fear of negative impact of medications on fetal development. On the contrary, active inflammation of the mother during pregnancy poses a greater risk to the fetus than adequate treatment. Commonly used drugs-aminosalicylates, corticosteroids, immunosuppressants and biological therapy appears to be safe and well tolerated during pregnancy. Method of delivery is individual and depends on the form and location of the inflammation and the preceding operations.

Keywords:
inflammatory bowel disease, Crohn‘s disease, ulcerative colitis, pregnancy, childbirth, breastfeeding


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Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

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2017 Issue 2

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