P363. Surgical management of ulcerative colitis during pregnancy
I. Wilson1, J. Dench1, W. Garrett1, 1Medway Martime Hospital, Surgery, Gillingham, United Kingdom
Severe ulcerative colitis (UC) occasionally requires surgical management. When surgery is indicated during pregnancy there is understandably great concern regarding the possible adverse effects of surgery on both mother and foetus. We present a case of a subtotal colectomy and ileostomy in a woman twenty-five weeks pregnant with the pregnancy continuing after surgery. Alongside this we present a literature review on the impact of surgery for UC in pregnant women with pregnancy continuing after surgery.
A MEDLINE search was undertaken to identify reports on surgery for UC in pregnant women. Reports of synchronous surgery and Caesarean section or delivery were excluded. We collected data on maternal age, indication for surgery, gestational age at time of surgery and type of surgical procedure. Any data on time and method of delivery, along with information on maternal or foetal morbidity and mortality were also recorded.
Including the present case, we identified 22 cases of UC managed by surgical intervention during pregnancy. The median age of the patients was 29 years (18–35years). The majority (59%) of the patients were in their second trimester. Twenty-one procedures were documented in twenty women: fourteen women underwent subtotal colectomy and ileostomy, one woman had total colectomy and ileostomy, four women had a colostomy and ileostomy, with the remaining cases involving terminal ileostomy or transverse colostomy alone. There were five cases of foetal mortality and three of maternal mortality. All the cases of maternal mortality were associated with foetal mortality. All cases of maternal and foetal mortality were reported prior to 1974. Maternal morbidity was documented in five women, including splenic rupture, two abscesses and one case of wound infection. One patient who underwent colostomy and ileostomy required subtotal colectomy seven days later.
Surgery for UC during pregnancy historically carried significant risk for both mother and foetus. This review demonstrates that in the present day surgery for UC during pregnancy can be undertaken with minimal maternal and foetal morbidity, let alone mortality. Following any surgical intervention it is possible for the pregnancy to continue safely. When indicated, surgical intervention for UC should not be delayed because of fears of adverse effects on pregnancy. The authors of this paper recommend undertaking subtotal colectomy and ileostomy.