DDSEP® 8 Quick Quiz

September 2018 Question 1

A 28-year-old woman with a history of Crohn's disease is 29 weeks pregnant. She has had an ileocolonic resection and continues to have a small enterocutaneous fistula. She is otherwise doing well, and is maintained on infliximab therapy. She is asking about the mode of delivery of her baby. She wants to know if she should have an elective cesarean delivery.

In which of the following clinical scenarios would a cesarean delivery be recommended?

DDSEP® 8 Quick Quiz - September 2018 Question 1

A) Ileal pouch-anal anastomosis

B) Enterocutaneous fistula

C) Infliximab therapy

D) Active perineal Crohn's disease

E) Pyoderma gangrenosum

Q1. Correct Answer: D


There is a risk of perineal trauma with vaginal delivery, and therefore, patients with active perianal Crohn's disease should undergo cesarean delivery to avoid exacerbation of disease. Patients without a history of perianal disease or those with inactive perianal disease have a low rate of relapse, and cesarean delivery is not warranted. Aside from patients with active perineal disease, the mode of delivery should be left to the discretion of the obstetrician. None of the other choices above, including ileal pouch-anal anastomosis, justify the decision to perform cesarean section.

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