Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.
Center for Clinical Epidemiology, Odense University Hospital, OdenseDenmark.
J Crohns Colitis. 2022 May 10;16(4):625-632. doi: 10.1093/ecco-jcc/jjab187.
Our aim is to determine the 30-day postpartum surgical complications in women with inflammatory bowel disease [IBD] who undergo a caesarian section rather than a vaginal delivery.
Using the Danish national registries, we established a study population of liveborn singleton births from January 1, 1997, through December 2015. We examined all mothers with IBD who had a caesarian section or a vaginal delivery. We examined 30-day maternal postpartum abdominal and perineal surgical outcomes and adjusted for multiple confounders. We examined acute versus elective caesarian sections and the effect of immunosuppressive therapies on outcomes.
In women with IBD, 2.1% undergoing caesarian section [n = 3255] versus 0.3% undergoing vaginal delivery [n = 6425] had a surgical complication. Women with IBD who had a caesarian section were more likely to have small bowel and colon surgery (adjusted odds ratio [aOR] 5.00, 95% confidence interval [CI] 2.00-12.51). Similar results were found regardless of acute [aOR 4.51, 95% CI 1.48-13.76] or elective [aOR 6.52, 95% CI 2.45-17.33] caesarian section. The risk of surgery after caesarian section was increased regardless of immunosuppressive use [aOR with immunosuppressives 8.79, 95% CI 2.86-27.05; and aOR without immunosuppressives 4.49, 95% CI 1.74-11.58].
The risk of a surgical complication after caesarian section as compared with a vaginal delivery is increased in women with IBD, regardless of whether the caesarian is performed for acute or elective reasons and/or of immunosuppressive use before delivery. Due to this increased risk, physicians should perform a caesarian delivery as the exception rather than the rule.
我们的目的是确定患有炎症性肠病（IBD）的女性行剖宫产而非阴道分娩后 30 天的产后手术并发症。
使用丹麦国家登记处，我们建立了 1997 年 1 月 1 日至 2015 年 12 月间活产单胎分娩的研究人群。我们检查了所有患有 IBD 且行剖宫产或阴道分娩的产妇。我们检查了 30 天的产妇腹部和会阴手术结局，并对多种混杂因素进行了调整。我们检查了急症与择期剖宫产术以及免疫抑制治疗对结局的影响。
在患有 IBD 的女性中，行剖宫产术的 2.1%（n=3255）与行阴道分娩的 0.3%（n=6425）发生手术并发症。行剖宫产术的 IBD 女性更有可能进行小肠和结肠手术（调整后的优势比[aOR]5.00，95%置信区间[CI]2.00-12.51）。无论急症（aOR 4.51，95% CI 1.48-13.76）还是择期（aOR 6.52，95% CI 2.45-17.33）剖宫产术，均有类似的结果。无论是否使用免疫抑制剂，行剖宫产术后手术的风险均增加（使用免疫抑制剂的 aOR 8.79，95% CI 2.86-27.05；不使用免疫抑制剂的 aOR 4.49，95% CI 1.74-11.58）。
与阴道分娩相比，IBD 女性行剖宫产术后发生手术并发症的风险增加，无论剖宫产术是急症还是择期进行，以及/或分娩前是否使用免疫抑制剂。由于这种风险增加，医生应将剖宫产术作为例外而非常规进行。
