Perineal Outcomes After Delivery in 179 Mothers with Inflammatory Bowel Disease Compared to 31 258 Controls: A Single-Centre Cohort Study

Background: Women with inflammatory bowel disease [IBD] have an increased risk for caesarean section [CS], but perineal obstetric outcomes, which may have significant consequences for women with IBD, have not been previously studied.

Method: Maternal outcomes in singleton pregnancies of IBD and non-IBD patients [2014-2018] in a single centre were studied.

Results: In 31 528 non-IBD and 179 IBD patients delivery by CS was more likely in IBD patients (p = 0.0021, relative risk [RR] 1.45, confidence interval [CI] 1.16-1.81). Elective CS in IBD patients occurred in 40% for IBD indications, all in accordance with current international guidelines. Perineal trauma, including tears involving the anal sphincter, were equally uncommon in IBD [2.23%] and non-IBD patients [3.40%; p = 0.35, RR 0.64, CI 0.24-1.68]. Of the four IBD patients with clinically significant tears, none had pelvic floor dysfunction or incontinence at follow-up in a specialist postnatal perineal trauma clinic. One IBD patient who had a clinically non-significant second-degree perineal tear reported incontinence a year after giving birth. Previous perianal disease was not associated with significant perineal trauma.

Conclusion: The low rate of perineal trauma is reassuring for promotion of vaginal delivery in most IBD patients. In those who experienced tears involving the anal sphincter no continence issues occurred. Women with IBD having a greater incidence of delivery by CS was only partially explained by IBD indications.