Cheng Alice G, Oxford Emily C, Sauk Jenny, Nguyen Deanna D, Yajnik Vijay, Friedman Sonia, Ananthakrishnan Ashwin N
*Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; †Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts; ‡Harvard Medical School, Boston, Massachusetts; and §Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts.
Inflamm Bowel Dis. 2014 Aug;20(8):1391-8. doi: 10.1097/MIB.0000000000000093.
Crohn's disease (CD) often affects women during the reproductive years. Although several studies have examined the impact of pregnancy on luminal disease, limited literature exists in those with perianal CD. Decision regarding mode of delivery is a unique challenge in such patients due to concerns regarding the effect of pelvic floor trauma during delivery on preexisting perianal involvement.
We performed a retrospective chart review of patients with CD with established perianal disease undergoing either vaginal delivery or caesarean section (C-section) at our institutions. We examined the occurrence of symptomatic perianal disease flares within 5 years after delivery in such women compared with nonpregnant CD controls. We also compared the occurrence of such flares between the 2 modes of delivery in women with established perianal CD.
We identified 61 pregnant patients with CD with established perianal disease (11 vaginal delivery, 50 through C-section) and 61 nonpregnant CD controls with perianal disease. One-third of the C-sections were primarily for obstetric indications. Six of the vaginal deliveries were complicated. Approximately, 36% of cases had a symptomatic perianal flare within 1 year after delivery. This was similar across both modes of delivery (P = 0.53) and similar to nonpregnant patients with CD. There was no difference in the rates of perianal surgical intervention or luminal disease flares in our population based on mode of delivery or between pregnant patients with CD and nonpregnant CD controls.
We observed no difference in risk of symptomatic perianal flares in patients with established perianal CD delivering vaginally or through C-section.
克罗恩病（CD）常在育龄期女性中发病。尽管已有多项研究探讨了妊娠对肠道疾病的影响，但关于肛周克罗恩病患者的相关文献有限。由于担心分娩时盆底创伤对已有的肛周病变产生影响，此类患者的分娩方式抉择面临独特挑战。
我们对在本机构接受阴道分娩或剖宫产的已确诊肛周疾病的克罗恩病患者进行了一项回顾性病历审查。我们比较了这些女性分娩后5年内有症状的肛周疾病复发情况与非妊娠克罗恩病对照。我们还比较了已确诊肛周克罗恩病的女性两种分娩方式之间此类复发的发生率。
我们确定了61例已确诊肛周疾病的妊娠克罗恩病患者（11例阴道分娩，50例剖宫产）和61例有肛周疾病的非妊娠克罗恩病对照。三分之一的剖宫产主要是出于产科指征。6例阴道分娩有并发症。大约36%的病例在分娩后1年内出现有症状的肛周复发。两种分娩方式的情况相似（P = 0.53），且与非妊娠克罗恩病患者相似。在我们的研究人群中，基于分娩方式，或在妊娠克罗恩病患者与非妊娠克罗恩病对照之间，肛周手术干预率或肠道疾病复发率没有差异。
我们观察到，已确诊肛周克罗恩病的患者经阴道分娩或剖宫产，有症状的肛周复发风险没有差异。
