1Department of Surgery, Madigan Army Medical Center, Tacoma, Washington 2Division of Colorectal Surgery, Case Medical Center, Cleveland, Ohio 3Division of Colorectal Surgery, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts 4Department of Surgery, University of Cincinnati, Cincinnati, Ohio 5University of Pennsylvania Hospitals, Philadelphia, Pennsylvania 6University of Rochester Medical Center, Rochester, New York.
Dis Colon Rectum. 2014 Feb;57(2):174-8. doi: 10.1097/DCR.0b013e3182a41381.
The optimal delivery method in patients with Crohn's disease is unknown, and there is no large-scale evidence on which to base decisions.
The aim of this study was to compare delivery methods and outcomes in patients with and without Crohn's disease.
The Nationwide Inpatient Sample and International Classification of Diseases, Ninth Revision codes were used to identify childbirth deliveries. Patients were stratified by the presence or absence of Crohn's disease and perianal disease (anorectal fistula or abscess, rectovaginal fistula, anal fissure, and anal stenosis).
A large population-cohort database was used for the analysis.
The primary outcomes measured were cesarean delivery and perineal lacerations.
Of 6,794,787 pregnant women who delivered, 2882 had a diagnosis of Crohn's disease. Rates of cesarean delivery were higher in patients who had Crohn's disease with (83.1%) and without (42.8%) perianal disease in comparison with patients who did not have Crohn's disease with (38.9%) and without (25.6%) perianal disease (p < 0.001). Rates of 4th degree perineal lacerations were similar between patients who had or did not have Crohn's disease without perianal disease (1.4% vs 1.3%), but these rates increased significantly in patients with perianal disease (12.3%, p < 0.001). On multivariate analysis, perianal disease (OR, 10.9; 95% CI, 8.3-4.1; p < 0.001) and smoking (OR, 1.6; 95% CI, 1.5-1.7; p < 0.001) were independently associated with higher rates of 4th degree laceration. Crohn's disease was not independently associated with 4th degree laceration.
This was a retrospective study with the inherent limitations of large databases.
Patients with Crohn's disease have higher rates of cesarean delivery. Perianal disease predicts severe perineal laceration independent of the presence of Crohn's disease. In the absence of perianal disease, the method of delivery in women with Crohn's disease should be predicated on obstetric indication.
克罗恩病患者的最佳分娩方式尚不清楚，也没有大规模的证据可供决策参考。
本研究旨在比较有和无克罗恩病患者的分娩方式和结局。
本研究使用全国住院患者样本和国际疾病分类，第九版代码来确定分娩情况。患者按有无克罗恩病和肛周疾病（肛门直肠瘘或脓肿、直肠阴道瘘、肛裂和肛门狭窄）进行分层。
本研究使用大型人群队列数据库进行分析。
主要观察指标为剖宫产和会阴裂伤。
在 6794787 名分娩的孕妇中，有 2882 名被诊断为克罗恩病。患有克罗恩病伴（83.1%）和不伴（42.8%）肛周疾病的患者的剖宫产率高于不患有克罗恩病伴（38.9%）和不伴（25.6%）肛周疾病的患者（p < 0.001）。无肛周疾病的克罗恩病患者和非克罗恩病患者的 4 度会阴裂伤发生率相似（1.4% vs 1.3%），但患有肛周疾病的患者的发生率显著增加（12.3%，p < 0.001）。多变量分析显示，肛周疾病（OR，10.9；95%CI，8.3-4.1；p < 0.001）和吸烟（OR，1.6；95%CI，1.5-1.7；p < 0.001）与 4 度裂伤的发生率升高独立相关。克罗恩病与 4 度裂伤无独立相关性。
本研究为回顾性研究，存在大型数据库固有的局限性。
患有克罗恩病的患者剖宫产率较高。肛周疾病是预测严重会阴裂伤的独立因素，与克罗恩病的存在无关。在无肛周疾病的情况下，克罗恩病患者的分娩方式应根据产科指征来决定。
