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* = Presenting author

P619 Evaluation of a service to manage Inflammatory Bowel Disease (IBD) in Pregnancy.

C. Parker*1, J. Waugh2, M. Gunn1

1Royal Victoria Infirmary, Gastroenterology, Newcastle upon Tyne, United Kingdom, 2Royal Victoria Infirmary, Obstetrics, Newcastle upon Tyne, United Kingdom

Background

Following the publication of the ECCO consensus [1] for management of IBD in pregnancy a service was set up in our institution to optimise management of this group. Its' aim is to enable multidisciplinary management of patients with a gastroenterologist, obstetrician, colorectal surgeon and IBD specialist nurse. It provides a baseline health check in the early stages of pregnancy, more intensive foetal growth monitoring (additional growth scans at 28 and 32 weeks), discussion of delivery methods and anticipation of potential peripartum problems. A review of the service was performed after 18 months.

Methods

A retrospective review of medical notes was performed. Information was gathered on: diagnosis, previous surgery, parity, previous pregnancies, medication and disease activity both preconception and during pregnancy.

Results

Data was collected on 39 patients. 18 Crohns disease (CD), 21 ulcerative colitis (UC). Surgery: UC group 3/21 had previous surgery:2 ileoanal pouch, 1 subtotal colectomy. CD group 10/18 had previous surgery: 9 ileocolonic resections and 1 subtotal colectomy. Parity: 11=para 1,14=para 2, 11=para 3, 3=para 4, 1=para 1.

Medication: 17/39: no medication (8 UC, 9 CD). 4:infliximab, last infusion approximately 20/40, 12: azathioprine, 12: 5ASA.

Disease activity: 36/39 were well preconception; 1 was unwell around time of conception and had miscarriage at 11/40. 15/39 had a flare of disease activity: 1 settled with topical treatment, 3 with 5ASA, 11 required oral steroids. 3 of 4 patients on infliximab had a flare and all 3 required oral steroids. 1/4 had a stillbirth shortly after commencing steroids for a flare although had responded well.

Outcomes: 8/39 have not yet delivered; 3 are planned for elective CS (Caeserian section)for obstetric reasons, 1 planned for induction (small baby). 15/31 had CS; 2 ileo-anal pouches, 2 ileo-rectal anastomosis, 3 perianal disease, 8 for obstetric reasons. 1 stillbirth, 2 miscarriages, 13 normal vaginal delivery (NVD). No preterm births or low birth weights reported to date

Conclusion

Those with ileo-anal pouches and perianal disease are being appropriately considered for a planned CS. 42% of our patients have a NVD which as expected is lower than the general population. 38% of patients had a flare in disease during pregnancy which is higher than literature (30%). 73% required oral prednisolone. 2/3 adverse outcomes appear to be related to a flare in disease. Those on infliximab appear to be at high risk of flaring after their last dose around 20 weeks.

A combined service with a dedicated Gastreoenterology and Obstetric team is an essential part of a tertiary referral centre in order to pre-empt and pro-actively manage complications in pregnancy in IBD.

References:

[1] Janneke van der Woude et al. , (2010), European based consensus on reproduction in inflammatory bowel disease, Journal of Crohns and Colitis