Inflammatory bowel disease

Question 1

Outline risks, management of woman with IBD

Answer 1

Risks:

• Active disease: infertility, miscarriage but generally good prognosis.
• UC associated with increased flares; no increase in flares for CD
• Stomas: cracking, bleeding, obstruction more common.

Pre-conception:

• Advise to delay conception if recent flare/active disease.
• High dose folic acid.
• Can continue: azathioprine, 6-mercaptopurine.
• Management of acute flares same in pregnancy.

Management of flares:

• Investigations: FBC, CRP, albumin, stool culture, flexible sigmoidoscopy.
• Treatment:
  
  • 5-aminosalicylates: SSZ, mesalazine
  • Prednisone
  • Pouchitis: metronidazole.
  • Anti-TNFa infliximab, adalimumab.

Intrapartum:

• Consult gastroneterologist/bowel surgeon prior to delivery for advice on MoD
• CS may be indicated if:
  
  • Active perianal CD due to poor healing of perineum.
  • Rectovaginal fistulae
  • Pouches