Relationship between pregnancy, delivery, and ileal pouch-anal anastomosis for inflammatory bowel disease: a retrospective chart review.

Background: Pregnant women with inflammatory bowel disease (IBD) and an ileal pouch-anal anastomosis (IPAA) often receive conflicting medical advice regarding mode of delivery, and healthcare providers may have diverging opinions. Cesarean delivery is commonly performed out of concern of injuring the anal sphincter during vaginal delivery, causing poorer long-term pouch function. This study aims to describe rates of vaginal and cesarean delivery, complication rates and assess the impact of pregnancy and delivery on pouch function for patients with IBD and an IPAA. Methods: This retrospective single center chart review study included patients with IBD, an IPAA, and a completed pregnancy between January 1, 2002 and February 1, 2021. Patient demographics, IBD diagnosis, IPAA procedure details, mode of delivery and complications, and pouch function surrounding pregnancy were compared using descriptive statistics. Results: Sixty-two patients completed 85 pregnancies. Eighty-one percent of pregnancies had a cesarean delivery (69/85); of these, 51 (73.9%) were planned elective cesareans while 18 (26.1%) were urgent. Among the planned elective cesareans, 51.6% were indicated to prevent injury to the anal sphincter and preserve pelvic pouch function. Immediate risks of cesarean and vaginal delivery were similar to the general population. Rates of delivery intervention with episiotomy were high (50% of vaginal deliveries). All vaginal deliveries took place in the later 10 years of the study period. Pouch function postpartum was infrequently documented. Conclusions: Pregnant patients with IBD and an IPAA frequently had a cesarean delivery, often to avoid anal sphincter injury from vaginal delivery and preserve pelvic pouch function. Delivery practices shifted in the past 10 years to include vaginal delivery, likely reflecting an increased perceived safety of this delivery mode.