Surgical treatment of inflammatory bowel diseases and pregnancy

Ulcerative colitis (UC) and Crohn's disease (CD) affect women of reproductive age. Surgical intervention is often required. Therefore, the implications of disease treatment and pregnancy need to be understood. The standard surgery for UC is proctocolectomy, followed by ileal pouch anal anastomosis (IPAA). This review summarises the literature describing the effects of IPAA on gynaecologic and sexual health, fertility, pregnancy, labour and delivery. The emerging role of laparoscopic IPAA and the limited role of ileo-rectal anastomosis (IRA) are discussed. The experience with emergency surgery in pregnant women with ulcerative colitis is also presented. The literature explores two key issues of pregnancy in CD: the possible effect of pregnancy decreasing resection rates, and the optimal mode of delivery, especially in the setting of perianal CD. These two issues together with the available literature describing stoma function during pregnancy and the foetal outcome after surgical therapy are presented.