Adverse maternal outcomes after vaginal versus caesarean delivery in women with Crohn's disease and prior perianal surgery: a population-based study

BACKGROUND AND AIMS: For pregnant women with perianal Crohn's disease (CD), major guidelines recommend delivery by caesarean section (c-section) for active disease, and that delivery mode be governed by obstetric indications for women with inactive disease. However, a significant gray zone exists between active versus inactive disease, such as for women who had a history of prior perianal surgery. We examined adverse maternal outcomes of vaginal delivery versus c-section in women with perianal CD and prior perianal surgeries. METHODS: We used the Danish national registries to collect information on singleton live births from 1997 through 2022 by mothers with CD and previous perianal surgery. Adverse postpartum maternal outcomes included new perianal or intestinal surgery within 12 months, hospital diagnosed infection or outpatient antibiotic prescription within 6 months, and major haemorrhage within 3 days. Adjusted odds ratios (aOR) were estimated in logistic regression models. RESULTS: There were 704 deliveries by women with CD and prior perianal surgery, including 245 vaginal deliveries (34.8%) and 459 c-sections (65.2%). Women who delivered vaginally versus by c-section had less new perianal surgery (aOR 0.47, 95% CI, 0.24-0.93) and no significant differences in intestinal CD surgery (aOR 0.87, 95% CI, 0.43-1.75), hospital diagnosed infection (aOR 0.50, 95% CI, 0.18-1.38), outpatient antibiotic prescription (aOR 0.92, 95% CI, 0.65-1.28), or major hemorrhage (aOR 0.79, 95% CI, 0.39-1.59). CONCLUSIONS: Vaginal delivery was not associated with increased important adverse maternal outcomes in mothers with CD and prior perianal surgery.