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.
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
University of California, San Francisco
Speakers
University of North Carolina
The University of Chicago
University of California san francisco
Tracks
Related Products
SINGLE-CELL AND SPATIAL MULTI-OMICS IDENTIFY INNATE AND STROMAL MODULES TARGETED BY ANTI-INTEGRIN THERAPY IN ULCERATIVE COLITIS
BACKGROUND: Mesenteric fat is increasingly believed to exert an important influence on intestinal inflammation. A hallmark of severe Crohn's disease (CD) is the accumulation of mesenteric fat around the inflamed intestine, typically in the terminal ileum…
IMIBD Late Breakers and Innovations in IBD
SOCIETY: AGA By popular demand, this new session highlights the best late-breakers submitted to the IBD section and well as innovations in technology and new paradigms of care in IBD
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…
