Crohn's disease-a chameleon during pregnancy.
BACKGROUND
In the past, women with Crohn's disease (CD) as a risk factor in pregnancy were discouraged from becoming pregnant. Today, by contrast, gestation is medically acceptable in these patients despite several severe complications.


METHODS
We present the course of five female patients with CD requiring surgery during pregnancy and giving birth at our institution between 1998 and 2008. These cases as well as our treatment recommendations for patients wishing to have children and our approaches to the management of complications during pregnancy are discussed in the light of the literature.


CONCLUSIONS
Three of five women had a preterm delivery (26 to 31 weeks' gestation) with a decreased neonatal weight. Generally, the diagnosis of CD is often delayed and diagnostic errors (four of five women) are not uncommon. The symptoms vary widely and include those typical of pregnancy. Three patients had to have a cesarean and only two patients were able to deliver vaginally. Especially in pregnant patients, the course of the disease is highly variable and difficult to predict. Our experience suggests that patients should be advised to conceive during remission. Indications for surgery in pregnant patients are the same as for nonpregnant women and include perforation, obstruction, hemorrhage, and abscess. The advantages of endoscopic surgery also apply to pregnant patients with acute manifestations. A stoma is not a contraindication to vaginal delivery.
Czymek
Ralf
R
Department of Surgery, University of Luebeck Medical School, Ratzeburger Allee 160, Lübeck, Germany. ralf_czymek@web.de
Limmer
Stefan
S
Kleemann
Markus
M
Hildebrand
Philipp
P
Schmidt
Andreas
A
Jungbluth
Thomas
T
Roblick
Uwe
U
Kujath
Peter
P
Bruch
Hans-Peter
HP
D000293:Adolescent; D003424:Crohn Disease / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult