LAUSR

Background Management of pregnant women with inflammatory bowel disease (IBD) can be complex. Women often report getting conflicted information from different health care professionals and needing to attend too many hospital appointments. Following the success of other combined medical-obstetric clinics that were already running at Homerton hospital we set up a monthly IBD – obstetric clinic in January 2016. The aim of this study was to review the effect of this clinic on pregnancy outcomes. Method A retrospective review of patient records was performed to obtain patient demographics, medical, surgical and drug history, mode of delivery and birth weight from January 2016 to January 2018. Results A total of 45 pregnancies in 44 women were identified. 18 women have Crohn’s disease (CD) and 26 ulcerative colitis (UC). Most women were on some treatment with only 4 being on none. 21 women were on 5-ASA (oral, topical or both). 7 women were on thiopurines. 8 women were on biologics (Infliximab 3, adalimumab 4, vedolizumab 1). 5 women were on biologics and thiopurines (3 adalimumab, 2 infliximab). Biologics were stopped at 28 weeks in 6/8 women, 1 woman stopped at 20 weeks and in one case it was necessary to continue Adalimumab throughout the pregnancy. 2 patients needed treatment with prednisolone due to flare up during pregnancy. One woman was diagnosed with UC during pregnancy and required prednisolone. One woman with severe perianal CD needed surgical drainage during pregnancy. All pregnancies resulted in live births. Mean birth weight was 3203 g. 7 women had emergency caesarean section (CS), 9 women elective CS and 5 had instrumental deliveries. The commonest indications for elective CS were obstetric or maternal choice and emergency CS foetal distress or failure to progress. There were 5 preterm deliveries (<37 weeks), 4 spontaneous, 1 emergency. There was one birth with severe intrauterine growth retardation (IUGR) secondary to a large placental haemorrhage at the beginning of the pregnancy and 1 duodenal atresia. One woman on infliximab and azathioprine developed listeria sepsis 10 days after the last infliximab infusion at 28 weeks. This was identified and treated appropriately, the pregnancy continued to term with no foetal complications. Average number of clinic visits was 3. There were a total of 115 appointments with a rising trend as the clinic became established and better known to GPs and midwives. Conclusion This study showed that a combined IBD-obstetric clinic improves adherence to treatment and guidelines with good pregnancy outcomes. Patient feedback is that they value this combined approach both in terms of the medical/obstetric expertise and in terms of convenience.