Oral Presentation Australasian Diabetes in Pregnancy Society and Society of Obstetric Medicine Australia and New Zealand Joint Scientific Meeting 2021

Management and outcomes during pregnancy in women with Inflammatory Bowel Disease in a London tertiary hospital (#34)

Preeti Sandhu 1 , Jessica McMicking 2 , Joel Mawdsley 3 , Maryann Quaye 2 , Lisa Story 2 , Anita Banerjee 2
  1. GKT School of Medical Education, King’s College London, London, United Kingdom
  2. Women’s Services, Guy’s & St Thomas’ NHS Foundation Trust, London
  3. Gastroenterology Department, Guy’s & St Thomas’ NHS Foundation Trust, London

Introduction

Women with Inflammatory Bowel Disease (IBD) have been shown to have poorer outcomes in pregnancy1, thus the importance of a multidisciplinary team (MDT) approach with suitable birth plans is vital during pregnancy for optimal outcomes.

Aim

To characterise IBD women attending services for obstetrics care and identify outcomes in pregnancy and areas of improvement for patient management at our institute.

Method

A retrospective analysis was conducted on women with IBD for pregnancy care in our tertiary hospital in 2019 and 2020. Of those booked in 2020, three are still to deliver. Antenatal data collected included: IBD medications, disease activity and number of appointments. Intrapartum data included: mode of delivery, complications during delivery and adverse outcomes. 

Results

The number of women with IBD in our service remained stable across 2019 (n=24) and 2020 (n=20).  45% of women had Crohn’s Diseases, 45% Ulcerative Colitis, and 10% were unclassified. 73% of women were on biologic medication during pregnancy. The number of flares reduced from 2019 (n=8) to 2020 so far (n=2).

The rate of caesarean sections was higher than the NHS average2, with a total of 43% (n=19) performed in women with IBD in 2019 and 2020, of which 42% (n=8) having had previous surgery for IBD and two requiring involvement of colorectal surgeons. Five (26%) of the caesarean sections performed were as emergencies. Other complications included three placental abruptions and one third degree tear with a forceps delivery. The rate of preterm birth was 16%.

The number of virtual and face-to-face appointments were also recorded to assess for differences due to the COVID-19 pandemic. There was variation in the number of clinician appointments, and overall an increase in the number of virtual obstetric medicine appointments from 2019 (n=2%) to 2020 (n=29%) as well as obstetric appointments (2019 n=3%, 2020 n=14%).

Discussion/Conclusion

This analysis has shown a high number of women with IBD delivering by caesarean section in pregnancy, including as emergencies. Birth planning during remission and management of IBD symptoms is essential in minimising adverse pregnancy outcomes. An increase in virtual appointments reflects the challenges of continuing to provide optimal care during pregnancy whilst accounting for changing healthcare provision during a pandemic. Constructing the MDT clinic with a clearer pathway and utilisation of virtual appointments is required to better streamline the service.