Ulcerative Colitis

Question 1

What are the maternal symptoms of ulcerative colitis?

Answer 1

Diarrhea, often with blood or pus.
Abdominal pain and cramping.
Rectal pain.
Rectal bleeding.
Urgency to defecate.
Inability to defecate despite urgency.
Weight loss.
Fatigue.

Question 2

How do you counsel patient regarding maternal and obstetric risks of ulcerative colitis?

Answer 2

• Increased risk for preterm birth, low birth weight, and being small for gestational age.
• No increased risk for congenital anomalies.

Question 3

What are the most common pregnancy complications in a patient with ulcerative colitis?

Answer 3

• Risk of flare, more likely to occur if patient is not in remission
• Cesarean section is performed in up to 44% of patients with IBD, which is higher than the general population

Question 4

How do you follow a patient with ulcerative colitis during pregnancy?

Answer 4

-Detailed anatomic survey and fetal growth
-Assess for flares and proceed with treatment:
Antidiarrhea
Steroids
Sulfasalazine
Mesalamine

Question 5

How do you counsel a patient regarding the use of mesalamine during pregnancy?

Answer 5

Human reports have not shown an increase in malformations after pregnancy exposure to mesalamine.

Question 6

Do you recommend a vaginal delivery in patients with UC? What would be an indication for c-section?

Answer 6

Yes. C-section is reserved for patients with perineal disease

Question 7

How do you manage a patient with UC flare in pregnancy?

Answer 7

Antidiarrhea
Steroids 
Sulfasalazine 
Mesalamine 
Can use Anti TNF if others fail such as infliximab 

Surgery for IBD during pregnancy is done for emergencies such as intestinal obstruction, perforation, abscess, or fulminant colitis.