S123 Maternal and Fetal Outcomes After IBD Surgery During Pregnancy

Abstract

Background: Inflammatory bowel disease (IBD) incidence peaks in the reproductive years. Despite advances in medical treatment, approximately 20% of ulcerative colitis (UC) and 80% of Crohn’s disease (CD) patients require surgical intervention during their lifetime. Active disease during pregnancy increases the risk of negative pregnancy outcomes, such as spontaneous abortion, low birth weight, prematurity and deformities. Achieving remission prior to conception and maintaining it throughout the pregnancy remain of utmost importance. However, surgery during pregnancy may be required for medically refractory disease or for disease-related complications such as intraabdominal abscess, perforation, or toxic megacolon. Literature pertaining to the maternal and fetal outcomes after IBD surgery during pregnancy remains scarce. Methods: This is a case series of 3 patients who underwent surgery for IBD during pregnancy and subsequently delivered at our quaternary IBD referral center. Results: Case 1: A 34-year-old female with recently diagnosed indeterminate colitis presented with disease exacerbation during her fifth gestational week. Despite treatment with mesalamine, methylprednisolone, and infliximab, she had persistent hematochezia, abdominal pain, and distention. On 11w6d of pregnancy, she underwent an open subtotal colectomy with end ileostomy for severe colitis. Postoperative period was uncomplicated. She then underwent a C-section at 38w5d of gestation. Baby weighed 2.9 kg, Apgar scores 9-9. The newborn had a cleft in the posterior soft palate, micrognathia, tongue tie, and laryngomalacia resulting in dyspnea and dysphagia, which required operative intervention during infancy. The mother ultimately underwent completion proctectomy with IPAA and ileostomy closure at 5- and 7-months following delivery, respectively. Postoperative pouch function was normal. During routine follow-up, pouchoscopy revealed cuffitis, which responded to mesalamine suppository. Case 2: A 28-year-old female with an 8-year history of UC previously treated with prednisone and azathioprine developed disease exacerbation during her 11th gestational week. During 25th week of pregnancy, she underwent an open subtotal colectomy with end ileostomy for acute severe ulcerative colitis. Postoperative period was uncomplicated. She underwent C-section at 39th week of gestation. Baby weighed 3.7 kg, Apgar scores 3-3-8. The newborn developed dyspnea which was resolved following positive pressure ventilation in the NICU for 30 hours. The mother underwent completion proctectomy with IPAA and ileostomy closure 2 years after delivery. Four years following pouch creation, she developed pouchitis, which was controlled with vedolizumab. Case 3: A 20-year-old female with recently diagnosed Crohn’s disease had disease exacerbation at 4 weeks gestation despite treatment with adalimumab and prednisone. A pelvic abscess was identified via ultrasound requiring percutaneous drainage twice. During the ninth week of pregnancy, she underwent a laparoscopic converted to open ileocecectomy due to recurrent abscess and abdominal pain. Postoperative period was uncomplicated. The pregnancy was complicated by pre-eclampsia in the third trimester. The patient had a vaginal delivery at 37w6d of gestation. Baby weighed 2.7 kg, Apgar scores 8-9. The post-delivery course of the mother and infant was uncomplicated. Conclusions: IBD affects females during their childbearing ages. IBD surgery at times needs to be done urgently/emergently; acceptable maternal and fetal outcomes can be achieved.