Lewin Sara, Long Millie, Cohen Russell, Scherl Ellen, Wolf Douglas, Mahadevan Uma
Division of Gastroenterology, University of California, San Francisco, San Francisco, CA, USA.
Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA.
Inflamm Bowel Dis. 2025 Aug 1;31(8):2106-2111. doi: 10.1093/ibd/izae310.
Women with inflammatory bowel disease (IBD) face complexities of disease management during pregnancy and childbirth. Apprehension regarding vaginal delivery in pregnant individuals with IBD persists due to concern for perianal disease and perineal trauma. The incidence of poor wound healing after obstetric anal sphincter injury is approximately 4% in the general population. In an IBD population, risk of developing and difficulty healing perineal tears and episiotomy is not well described.
In a multicenter prospective cohort of pregnant individuals with IBD, we collected demographic information, IBD disease and treatment history, pregnancy and labor history, and reports of delayed wound healing >1 month from episiotomy, vaginal tear, or Cesarean (C-) section. Prospective data were collected using questionnaires that were administered each trimester of pregnancy, at delivery, and in the year postpartum.
There were 743 patients in the PIANO registry who answered questions pertaining to postpartum wound healing, with 330 (44%) reporting a C-section and 413 (56%) reporting a vaginal delivery. Of 119 C-section deliveries assessed for delayed wound healing, only 1 (0.8%) patient reported this complication. Episiotomies were reported in 59 (14%) patients, with 9 (15%) reporting delayed wound healing. Vaginal tears were reported in 252 (64%) patients. Delayed wound healing from vaginal tear was reported in 9% of patients. Use of immunomodulators was associated with delayed wound healing from episiotomy (33% vs 0% for those on no medications, P = .024). No difference was seen in wound healing time for episiotomy with other medications, including corticosteroids, anti-tumor necrosis factor, or anti-integrin use. Delayed wound healing from vaginal tear was not associated with any class of IBD medication.
Episiotomy was a common occurrence in patients with IBD. Immunomodulator, but not biologic, use was found to be associated with delayed wound healing. This association could reflect a direct medication effect on episiotomy wound healing or inadequate treatment of underlying active disease prior to delivery. Vaginal tears were also common but delayed wound healing was not associated with IBD therapy. C-section occurred at high rates, particularly in Crohn's disease patients, with no reported delays in postpartum wound healing.
炎症性肠病（IBD）女性在妊娠和分娩期间面临疾病管理的复杂性。由于担心肛周疾病和会阴创伤，患有IBD的孕妇对阴道分娩仍存在担忧。在普通人群中，产科肛门括约肌损伤后伤口愈合不良的发生率约为4%。在IBD人群中，会阴撕裂和会阴切开术后发生和愈合困难的风险尚无充分描述。
在一个多中心前瞻性队列研究中，我们收集了患有IBD的孕妇的人口统计学信息、IBD疾病和治疗史、妊娠和分娩史，以及会阴切开术、阴道撕裂或剖宫产（C-）术后伤口愈合延迟>1个月的报告。前瞻性数据通过在妊娠各期、分娩时和产后一年内发放的问卷收集。
PIANO登记处有743名患者回答了与产后伤口愈合相关的问题，其中330名（44%）报告为剖宫产，413名（56%）报告为阴道分娩。在119例接受剖宫产且评估伤口愈合延迟的患者中，只有1例（0.8%）报告了该并发症。59例（14%）患者进行了会阴切开术，其中9例（15%）报告伤口愈合延迟。252例（64%）患者发生了阴道撕裂。9%的患者报告阴道撕裂后伤口愈合延迟。使用免疫调节剂与会阴切开术后伤口愈合延迟相关（使用免疫调节剂的患者为33%，未用药患者为0%，P = 0.024）。使用其他药物（包括皮质类固醇、抗肿瘤坏死因子或抗整合素）进行会阴切开术的伤口愈合时间无差异。阴道撕裂后伤口愈合延迟与任何一类IBD药物均无关。
会阴切开术在IBD患者中很常见。发现使用免疫调节剂而非生物制剂与会阴切开术后伤口愈合延迟相关。这种关联可能反映了药物对会阴切开术伤口愈合的直接影响，或者分娩前对潜在活动性疾病的治疗不足。阴道撕裂也很常见，但伤口愈合延迟与IBD治疗无关。剖宫产发生率较高，尤其是在克罗恩病患者中，未报告产后伤口愈合延迟情况。
