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P434 Joint Inflammatory Bowel Disease–Obstetric clinics: outcomes in 95 pregnancies at a tertiary centre over a 3-year period

Chew T.S.*1, Carmichael M.S.1, Hoare T.W.2, Waugh J.3, Gunn M.C.1

1Royal Victoria Infirmary, Department of Gastroenterology, Newcastle upon Tyne, United Kingdom 2Royal Victoria Infirmary, Department of Radiology, Newcastle upon Tyne, United Kingdom 3Royal Victoria Infirmary, Department of Obstetric and Gynaecology, Newcastle upon Tyne, United Kingdom

Background

Management of pregnant patients with inflammatory bowel disease (IBD) can be complex, requiring joint specialist multi-disciplinary clinical knowledge and skills. To this end, a joint IBD-Obstetric clinic was started in May 2013. The aim of this study was to identify the benefits of a joint service in improving adherence to ECCO guidelines and pregnancy outcomes.

Methods

Retrospective review of records to obtain: patient demographics, clinic attendance, disease parameters, drug, surgical and obstetric history, investigations, treatment changes, mode of delivery and birth weight over a period of 3 years from May 2013 till May 2016.

Results

A total of 95 pregnancies in 89 women (mean age 31, age range 19–43) were identified. 39 women had Crohn's disease, 49 ulcerative colitis and 1 IBD-unclassified. 37 women were on 5ASA, 20 Azathioprine, 5 Infliximab, 4 Adalimumab and 2 on combination Azathioprine-Anti-TNF-Ab. Treatments started or reinstated during pregnancy: 25 prednisolone, 16 5ASA and 30 topical therapy in keeping with ECCO Statement 5C. No women were started on anti-TNF Ab but two women had an increase in Adalimumab dose. 5/6 women had infliximab till week 25 in accordance with ECCO Statement 5D. 93% women were well pre-conception and 49% had no flare during the pregnancy. Delivery: 31 women had an elective section, 17 an emergency section and 7 instrumental deliveries. The commonest indication for elective and emergency sections were maternal choice and pathological CTGs. 8 deliveries were preterm (32–36 weeks), 2 spontaneous, 6 planned. There were 5 births that were small for gestational age, 1 stillbirth and 2 cardiac congenital anomalies in this cohort, which is not statistically different from a recent large Australian population study by Shand et al. Haemoglobin, platelets, albumin and C-reactive protein were not predictive of preterm delivery or stillbirth. Most women were seen at least three times during the pregnancy, co-ordinating clinic appointments with scans at 20, 28 and 32 weeks, with an average of 100 appointments per year and a rising trend with time. Investigations: 9 women had small bowel ultrasound performed by a single experienced Radiologist, 4 non-gadolinium pelvic/small bowel MRIs and 2 sigmoidoscopies. All 15 investigations aided management decisions.

Conclusion

This study shows that an experienced joint IBD-Obstetric service improves adherence to ECCO guidelines with outcomes that compare favourably to existing published data of IBD care in pregnant patients.