WOUND HEALING AFTER EPISIOTOMY AND CESAREAN SECTION AMONG WOMEN WITH IBD

Background: Women with inflammatory bowel disease (IBD) face the 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 0.1-4.6% in the general population. In an IBD population, risk of developing and of poor healing of perineal tears and episiotomy is not well described.

Methods: In a multi-center 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 section. Data was collected using questionnaires that were administered each trimester of pregnancy and post-partum.

Results: There were 759 patients in the PIANO registry who answered questionnaire items pertaining to postpartum wound healing, with 330 (44%) reporting a cesarean section and 413 (54%) reporting a vaginal delivery (Table 1). The mean maternal age was 32. The mean number of pregnancies (including index pregnancy) was 2.1. Indications for c-section are shown in Table 2. Of 178 c-section deliveries assessed for delayed wound healing, only 1 (0.6%) 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. Use of immunomodulators was associated with delayed wound healing from episiotomy (33% as compared to 0% for those on no medications, p=0.024). No difference was seen in wound healing time for episiotomy with other medications, including corticosteroids, anti-TNF, or anti-integrin use.

Conclusions: 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. Cesarean section occurred at high rates, but without reported delays in postpartum wound healing.