Long-term evaluation of the impact of delivery modalities on anal continence in women with Crohn's disease - 29/09/22
Summary |
Context |
Crohn's disease (CD) and sphincter injury during childbirth are two risk factors for anal incontinence (AI). The long-term risk of developing AI in women with CD after childbirth has never been studied.
Goal |
The main objective of the study is to assess the risk of developing severe AI after childbirth in women with CD.
Methods |
A retrospective study was performed in women with CD who gave birth in a French “Level 3” maternity hospital between 2000 and 2015. The primary endpoint was severe AI as defined by a Wexner score≥9 or a St. Mark's score≥9, at least five years after childbirth. The association between delivery route and occurrence of severe AI was assessed by univariate and multivariate analyses.
Results |
Forty-six women were included, 32 of whom were delivered vaginally and 14 by Caesarean section. Thirty-one percent of the women had severe AI according to the Wexner score, and 41% according to the St. Mark's score. Two factors were associated with severe AI: vaginal delivery and the occurrence of an obstetric perineal injury: (crude OR=8.89, 95% (CI: 1.03–76.57) and crude OR=4.16, 95% (CI: 1.06–16.27) respectively for AI defined by the Wexner score, and crude OR=6.8, 95% (CI: 1.30–35.41) and crude OR=4.3, 95% (CI: 1.23–15.2) for AI defined by the St. Mark's score). After adjusting for confounding factors, only vaginal delivery was associated with severe AI (adjusted OR=22.86, 95% CI: 1.52–931.28 for a Wexner score≥9 and adjusted OR=16. 11 (95% CI: 1.43–533.26) for a St Mark score≥9).
Conclusion |
Vaginal birth was associated with the development of severe long-term AI in women with CD.
El texto completo de este artículo está disponible en PDF.Keywords : Crohn's disease, Anal incontinence, Childbirth, Pregnancy
Esquema
Vol 159 - N° 5
P. 353-361 - octobre 2022 Regresar al númeroBienvenido a EM-consulte, la referencia de los profesionales de la salud.
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