title: Crohn's disease and pregnancy: the impact of perianal disease on delivery methods and complications.
abstract: BACKGROUND
  The optimal delivery method in patients with Crohn's disease is unknown, and there is no large-scale evidence on which to base decisions.
  
  
  OBJECTIVE
  The aim of this study was to compare delivery methods and outcomes in patients with and without Crohn's disease.
  
  
  METHODS
  The Nationwide Inpatient Sample and International Classification of Diseases, Ninth Revision codes were used to identify childbirth deliveries. Patients were stratified by the presence or absence of Crohn's disease and perianal disease (anorectal fistula or abscess, rectovaginal fistula, anal fissure, and anal stenosis).
  
  
  METHODS
  A large population-cohort database was used for the analysis.
  
  
  METHODS
  The primary outcomes measured were cesarean delivery and perineal lacerations.
  
  
  RESULTS
  Of 6,794,787 pregnant women who delivered, 2882 had a diagnosis of Crohn's disease. Rates of cesarean delivery were higher in patients who had Crohn's disease with (83.1%) and without (42.8%) perianal disease in comparison with patients who did not have Crohn's disease with (38.9%) and without (25.6%) perianal disease (p < 0.001). Rates of 4th degree perineal lacerations were similar between patients who had or did not have Crohn's disease without perianal disease (1.4% vs 1.3%), but these rates increased significantly in patients with perianal disease (12.3%, p < 0.001). On multivariate analysis, perianal disease (OR, 10.9; 95% CI, 8.3-4.1; p < 0.001) and smoking (OR, 1.6; 95% CI, 1.5-1.7; p < 0.001) were independently associated with higher rates of 4th degree laceration. Crohn's disease was not independently associated with 4th degree laceration.
  
  
  CONCLUSIONS
  This was a retrospective study with the inherent limitations of large databases.
  
  
  CONCLUSIONS
  Patients with Crohn's disease have higher rates of cesarean delivery. Perianal disease predicts severe perineal laceration independent of the presence of Crohn's disease. In the absence of perianal disease, the method of delivery in women with Crohn's disease should be predicated on obstetric indication.
authors.affiliation: 1Department of Surgery, Madigan Army Medical Center, Tacoma, Washington 2Division of Colorectal Surgery, Case Medical Center, Cleveland, Ohio 3Division of Colorectal Surgery, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts 4Department of Surgery, University of Cincinnati, Cincinnati, Ohio 5University of Pennsylvania Hospitals, Philadelphia, Pennsylvania 6University of Rochester Medical Center, Rochester, New York.
authors.forename: Quinton
authors.initials: Q
authors.lastname: Hatch
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Champagne
authors.forename: Justin A
authors.initials: JA
authors.lastname: Maykel
authors.forename: Bradley R
authors.initials: BR
authors.lastname: Davis
authors.forename: Eric K
authors.initials: EK
authors.lastname: Johnson
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Bleier
authors.forename: Todd D
authors.initials: TD
authors.lastname: Francone
authors.forename: Scott R
authors.initials: SR
authors.lastname: Steele
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003424:Crohn Disease / Q000150:complications*; D004841:Episiotomy / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D022125:Lacerations / Q000453:epidemiology*; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D009772:Obstetrical Forceps; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D012002:Rectal Diseases / Q000150:complications*; D012189:Retrospective Studies; D014620:Vacuum Extraction, Obstetrical / Q000706:statistics & numerical data