658

WOUND HEALING AFTER EPISIOTOMY AND CESAREAN SECTION AMONG WOMEN WITH IBD

Date
May 20, 2024

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.

Presenter

Speaker Image for Sara Lewin
University of California, San Francisco

Speakers

Speaker Image for Millie Long
University of North Carolina
Speaker Image for Russell Cohen
The University of Chicago
Speaker Image for Uma Mahadevan
University of California san francisco

Tracks

Related Products

Thumbnail for PREGNANCY OUTCOMES AFTER MATERNAL OR PATERNAL EXPOSURE IN THE TOFACITINIB ULCERATIVE COLITIS CLINICAL PROGRAM
PREGNANCY OUTCOMES AFTER MATERNAL OR PATERNAL EXPOSURE IN THE TOFACITINIB ULCERATIVE COLITIS CLINICAL PROGRAM
BACKGROUND: Pregnant women with ulcerative colitis (UC) have a higher risk of adverse pregnancy outcomes vs age-matched controls.1 Tofacitinib is an oral Janus kinase inhibitor for the treatment of UC. There are no well-controlled studies on tofacitinib use in pregnant women…
Thumbnail for Epi II: Best of Observational Studies in IBD
Epi II: Best of Observational Studies in IBD
SOCIETY: AGA This session highlights the best of the best observational studies in IBD for DDW 2024 and provides clinical relevant and novel insights across the age and clinical spectrum, including wound healing after C-section…
Thumbnail for THE GUT MICROBIOME REGULATES THE CLINICAL EFFICACY OF SULFASALAZINE THERAPY FOR IBD-ASSOCIATED SPONDYLOARTHRITIS
THE GUT MICROBIOME REGULATES THE CLINICAL EFFICACY OF SULFASALAZINE THERAPY FOR IBD-ASSOCIATED SPONDYLOARTHRITIS
Joint inflammation, or spondyloarthritis (SpA), is a common extra-intestinal manifestation of inflammatory bowel disease (IBD) and associated with changes in the gut microbiome…
Thumbnail for TL1A DRIVES ILC-MEDIATED GRANULOPOIESIS AND COLITIS ASSOCIATED CANCER
TL1A DRIVES ILC-MEDIATED GRANULOPOIESIS AND COLITIS ASSOCIATED CANCER
Inflammatory changes play an important role in tumorigenesis, and patients with chronic inflammatory bowel disease (IBD) are at an increased risk of developing colitis-associated cancer (CAC). However, the cellular contributions of these inflammatory changes in CAC are not well defined…