How to Approach Delivery in Patients with IBD

On the basis of data given in the literature, patients with RCU may expect ordinary labour and a transvaginal delivery unless there are contraindications connected with concomitant morbid conditions. This consideration is generally valid also for patients who underwent IPAA, as transvaginal delivery does not seem to considerably compromise the integrity of anastomosis [36]. However, as will be discussed later, there is still no consensus regarding this subject.

Differently from pregnant women with UC, most patients with CD, especially those with active perineal involvement, should have a caesarean deliver. If transvaginal delivery cannot be avoided, episiotomy should be avoided [37]. If unavoidable, a mediolateral episiotomy is preferable in order to avoid anal sphincter damage. According to recent studies, development of new perineal complications after transvaginal delivery, usually associated with epi-siotomy, in patients without previous perineal disease is 17.9%. Moreover, while planning how to perform the delivery, the obstetrician should take into account the specific features of each patient.

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