Not Too Late to Make Cutting-Edge Decisions: Editorial Response to ‘Predictors of Cesarean Delivery in Pregnant Women with Inflammatory Bowel Disease’
Notice bibliographique
Résumé
In this issue of JCAG, Sharaf and Nguyen report on the predictors of Cesarean delivery in pregnant women with inflammatory bowel disease (IBD) (1). This retrospective study reviewed all deliveries over an 8-year period at a tertiary referral institution. Consistent with existing literature, which have demonstrated up to a two-fold risk of Cesarean delivery in the IBD population over the general population (2), Sharaf et al. reported 52% of those with Crohn’s disease and 48% with ulcerative colitis underwent Cesarean delivery. The Toronto Consensus Statements for the Management of IBD in Pregnancy (which includes three statements addressing mode of delivery) was published in Gastroenterology in 2016 (3), postdating the study period (2006–2014) of Sharaf’s paper (1). The panel, which included expertise in IBD, obstetricians and maternofetal medicine, provided a strong recommendation that the decision regarding Cesarean delivery should be based on obstetric considerations and not the diagnosis of IBD alone (statement 21) (3). However, exceptions may be made in two specific scenarios: the presence of active perianal disease and patients who have undergone an ileal pouch anal anastomosis (statements 21 and 22). Sharaf et al. observed that a history of perianal disease was the strongest predictor of Cesarean delivery in women with CD, with an adjusted odds ratio of 13.6 (95% CI, 3.87–47.5). However, it should be noted that the guidelines specify that this strong recommendation is reserved for women with active perianal disease, as disease activity may be a risk factor for worsening symptoms (4) and perineal lacerations (5). In Sharaf et al.’s cohort, only 42% of women with perianal disease had active symptoms during pregnancy, suggesting the presence of other risk factors for Cesarean delivery. Overall, prior Cesarean delivery was the strongest predictor of Cesarean delivery in women with CD (aOR 22.2; 95% CI, 6.16–80.2), highlighting the importance of initial judicious decision-making by obstetrics, other medical care providers and patients regarding mode of delivery. While there are emergency, elective, obstetric, and gastroenterologic indications, and not withstanding personal preference for Cesarean delivery, elective gastroenterologic indications should constitute the minority of procedures. The other scenario in which Cesarean delivery should also be considered is in women with IBD who have undergone an ileal pouch anal anastomosis (IPAA), in order to reduce the risk of anal sphincter injury which may lead to fecal incontinence. Sharaf et al. report that within the UC population, prior colectomy increased the odds five-fold of requiring a Cesarean delivery; however, the proportion of these women who had a ileostomy versus an IPAA at time of pregnancy was not reported (1). Overall, Sharaf and Nguyen’s study contributes to the growing body of evidence that women with IBD undergo Cesarean delivery at a rate exceeding the general population and perhaps contrary to the defined indications outlined by the 2016 Toronto Consensus Statements for the Management of IBD. Future studies could take into account factors including the publication of the guidelines, geographical variation and institution (academic versus community). Accordingly, more targeted education can be provided with the hope that outcomes such as mode of delivery for pregnant women with IBD can more closely approximate that of the general public.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,012 | 0,093 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,002 |
| Méta-épidémiologie (sens large) | 0,006 | 0,003 |
| Bibliométrie | 0,004 | 0,002 |
| Études des sciences et des technologies | 0,004 | 0,004 |
| Communication savante | 0,009 | 0,005 |
| Science ouverte | 0,006 | 0,002 |
| Intégrité de la recherche | 0,032 | 0,037 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,007 | 0,006 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».