Pregnancy and delivery before and after ileal pouch-anal anastomosis for inflammatory bowel disease: immediate and long-term consequences and outcomes.

Détails

ID Serval
serval:BIB_74CE0175686A
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Pregnancy and delivery before and after ileal pouch-anal anastomosis for inflammatory bowel disease: immediate and long-term consequences and outcomes.
Périodique
Diseases of the Colon and Rectum
Auteur(s)
Hahnloser D., Pemberton J.H., Wolff B.G., Larson D., Harrington J., Farouk R., Dozois R.R.
ISSN
0012-3706 (Print)
ISSN-L
0012-3706
Statut éditorial
Publié
Date de publication
2004
Volume
47
Numéro
7
Pages
1127-1135
Langue
anglais
Notes
Publication types: Comparative Study ; Journal ArticlePublication Status: ppublish
Résumé
PURPOSE: This study was designed to evaluate pregnancy, delivery, and functional outcome in females before and after ileal pouch-anal anastomosis for chronic ulcerative colitis.
METHODS: From a prospective database of 1,454 patients who underwent ileal pouch-anal anastomosis for chronic ulcerative colitis between 1981 and 1995, a standardized questionnaire was sent to all female patients aged 40 years or younger at the time of ileal pouch-anal anastomosis (n = 544).
RESULTS: The response rate was 83 percent (450/544) with a mean follow-up after ileal pouch-anal anastomosis of 13 years. A total of 141 females were pregnant after the chronic ulcerative colitis diagnosis, but before ileal pouch-anal anastomosis (236 pregnancies; mean, 1.7) and 87 percent delivered vaginally. A mean of five (range, 1-16) years after ileal pouch-anal anastomosis, 135 females were pregnant (232 pregnancies; mean, 1.7). Comparison of pregnancy and delivery before and after ileal pouch-anal anastomosis in the same females (n = 37) showed no difference in birth weight, duration of labor, pregnancy/delivery complications, vaginal delivery rates (59 percent before vs. 54 percent after ileal pouch-anal anastomosis), and unplanned cesarean section (19 vs.14 percent). Planned cesareans occurred only after ileal pouch-anal anastomosis and were prompted by obstetrical concerns in only one of eight. Pouch function at first follow-up after delivery (mean, 7 months) was similar to pregravida function. After ileal pouch-anal anastomosis, daytime stool frequency was the same after delivery as pregravida (5.4 vs. 5.4, not significant) but was increased at the time of last follow-up (68 months after delivery; 5.4 vs. 6.4; P < 0.001). The rate of occasional fecal incontinence also was higher (20 percent after ileal pouch-anal anastomosis and 21 percent pregravida vs. 36 percent at last follow-up; P = 0.01). No difference in functional outcome was noted compared with females who were never pregnant after ileal pouch-anal anastomosis (n = 307). Age and becoming pregnant did not affect the probability of pouch-related complications, such as stricture, pouchitis, and obstruction.
CONCLUSIONS: Successful pregnancy and vaginal delivery occur routinely in females with chronic ulcerative colitis before and after ileal pouch-anal anastomosis. The method of delivery should be dictated by obstetrical considerations. Pouch function and the incidence of complications in females with pregnancies seem largely unaffected long-term.
Mots-clé
Adult, Colitis, Ulcerative/surgery, Colonic Pouches/physiology, Delivery, Obstetric/methods, Female, Humans, Pregnancy, Pregnancy Complications/physiopathology, Pregnancy Outcome, Proctocolectomy, Restorative/methods, Time Factors, Treatment Outcome
Pubmed
Web of science
Création de la notice
07/10/2014 14:46
Dernière modification de la notice
03/03/2018 18:22
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