Abstract
Background and aims
Enterostomy is often undergone by patients with Crohn’s disease (CD) due to severe anorectal lesions such as rectovaginal fistula (RVF). Reports of successful pregnancy and delivery, which are important determinants of quality of life for female CD patients with stoma, are limited. Thus, we investigated problems associated with pregnancy and delivery in female CD patients at our hospital.
Materials and methods
Between 1985 and 2003, five female CD patients with enterostoma carried seven pregnancies and delivered eight babies in our hospital. For this study, we investigated CD activity, fetal growth, stoma complications, and the outcome of delivery in these seven pregnancies.
Results
Among the five patients, four underwent loop ileostomy and one loop sigmoidostomy for treatment of RVF or severe stricture of the rectum or sigmoid colon. Except for one case, no fertility treatment was done. During pregnancy, a flare-up was observed in one patient and was successfully treated with corticosteroids. Although home enteral or parenteral nutrition was required in two cases, fetal growth was within the normal range in all pregnancies. Preterm delivery occurred in one case with a twin pregnancy. The mean diameter of stoma increased during pregnancy (p<0.01), and a mucosal laceration of stoma by the edge of an ostomy appliance occurred in one case. All deliveries were safe, with six cesarean sections and one transvaginal delivery. After each delivery, the stoma returned to pre-pregnancy size.
Conclusions
Pregnancy and delivery in CD patients with stoma is safe and should be encouraged. However, special attention to disease activity, nutritional support, and stoma-related complications is recommended.
Similar content being viewed by others
References
Lapidus A, Bernell O, Hellers G, Lofberg R (1998) Clinical course of colorectal Crohn’s disease: a 35-year follow-up study of 507 patients. Gastroenterology 114:1151–1160
Galandiuk S, Kimberling J, Al-Mishlab TG, Stromberg AJ (2005) Perianal Crohn disease: predictors of need for permanent diversion. Ann Surg 241:796–802
Michelassi F, Melis M, Rubin M, Hurst RD (2000) Surgical treatment of anorectal complications in Crohn’s disease. Surgery 128:597–603
Wikland M, Jansson I, Asztély M, Palselius I, Svaninger G, Magnusson O, Hultén L (1990) Gynaecological problems related to anatomical changes after conventional proctocolectomy and ileostomy. Int J Colorectal Dis 5:49–52
Nicholl MC, Thompson JM, Cocks PS (1993) Stomas and pregnancy. Aust N Z J Obstet Gynaecol 33:322–324
Mayberry JF, Weterman IT (1986) European survey of fertility and pregnancy in women with Crohn’s disease: a case control study by European collaborative group. Gut 27:821–825
Moody GA, Probert C, Jayanthi V, Mayberry JF (1997) The effects of chronic ill health and treatment with sulphasalazine on fertility amongst men and women with inflammatory bowel disease in Leicestershire. Int J Colorectal Dis 12:220–224
Lamah M, Scott HJ (2002) Inflammatory bowel disease and pregnancy. Int J Colorectal Dis 17:216–222
Hudson M, Flett G, Sinclair TS, Brunt PW, Templeton A, Mowat NA (1997) Fertility and pregnancy in inflammatory bowel disease. Int J Gynaecol Obstet 58:229–237
Arkuran C, McComb P (2000) Crohn’s disease and tubal infertility: the effect of adhesion formation. Clin Exp Obstet Gynecol 27:12–13
Marchesa P, Hull TL, Fazio VW (1998) Advancement sleeve flaps for treatment of severe perianal Crohn’s disease. Br J Surg 85:1695–1698
Halverson AL, Hull TL, Fazio VW, Church J, Hammel J, Floruta C (2001) Repair of recurrent rectovaginal fistulas. Surgery 130:753–758
Sonoda T, Hull T, Piedmonte MR, Fazio VW (2002) Outcomes of primary repair of anorectal and rectovaginal fistulas using the endorectal advancement flap. Dis Colon Rectum 45:1622–1628
Dominitz JA, Young JCC, Boyko EJ (2002) Outcomes of infants born to mothers with inflammatory bowel disease: a population-based cohort study. Am J Gastroenterol 97:641–648
Mottet C, Juillerat P, Gonvers JJ, Froehlich F, Burnand B, Vader JP, Michetti, Felley C (2005) Pregnancy and Crohn’s disease. Digestion 71:54–61
Woolfson K, Cohen Z, McLeod RS (1990) Crohn’s disease and pregnancy. Dis Colon Rectum 33:869–873
Agret F, Cosnes J, Hassani Z, Gornet JM, Gendre JP, Lémann M, Beaugerie L (2005) Impact of pregnancy on the clinical activity of Crohn’s disease. Aliment Pharmacol Ther 21:509–513
Moskovitz DN, Bodian C, Chapman ML, Marion JF, Rubin PH, Scherl E, Present DH (2004) The effect on the fetus of medications used to treat pregnant inflammatory bowel-disease patients. Am J Gastroenterol 99:656–661
Bendich A, Langseth L (1989) Safety of vitamin A. Am J Clin Nutr 49:358–371
Gopal KA, Amshel AL, Shonberg IL, Levinson BA, VanWert M, VanWert J (1985) Ostomy and pregnancy. Dis Colon Rectum 28:912–916
van Horn C, Barrett P (1997) Pregnancy, delivery, and postpartum experiences of fifty-four women with ostomies. J Wound Ostomy Continence Nurs 24:151–162
Brandt LJ, Estabrook SG, Reinus JF (1995) Results of a survey to evaluate whether vaginal delivery and episiotomy lead to perianal involvement in women with Crohn’s disease. Am J Gastroenterol 90:1918–1922
Rogers RG, Katz VL (1995) Course of Crohn’s disease during pregnancy and its effect on pregnancy outcome: a retrospective review. Am J Perinatol 12:262–264
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Takahashi, K., Funayama, Y., Fukushima, K. et al. Pregnancy and delivery in patients with enterostomy due to anorectal complications from Crohn’s disease. Int J Colorectal Dis 22, 313–318 (2007). https://doi.org/10.1007/s00384-006-0148-z
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-006-0148-z