Management of Inflammatory Bowel Disease in Pregnancy: Case Series of Patients Requiring Hospitalization
Bibliographic record
Abstract
Introduction: Inflammatory bowel disease (IBD) commonly affects females during their reproductive years. Pregnancy does not increase rate of relapse, but management in pregnancy is difficult. Anti-TNF agents are suggested to be safe in pregnancy and have reduced need for hospitalization and surgical management. We present 3 cases of severe Crohn's requiring hospitalization during pregnancy, 1 requiring surgical management, to show the contribution of a multimodality approach to patient diagnosis and management. Case 1: 32 year old female presents at 30 weeks gestation with right sided abdominal pain was admitted and treated for query UTI. She reports years of abdominal distension and food related diarrhea. Bowel ultrasound (US) showed severe inflammation of the terminal ileum with localized perforations of the bowel and a stricture causing incomplete small bowel obstruction consistent with Crohn's. She was treated with antibiotics with resolution of symptoms. She delivered vaginally at 40 weeks gestation and was started on adalimumab postpartum. Follow-up MRI and US showed no improvement of inflammation. Case 2: 30 year old female presents at 26 weeks gestation with abdominal pain and threatened preterm labor requiring hospitalization. She had a 2 year history of vague abdominal pain. Previous colonoscopy was non-diagnostic for IBD. US showed severe, acute inflammation of the terminal ileum with perforation and multifocal fistulae consistent with Crohn's. She was treated with antibiotics and steroids with improvement of her symptoms. She delivered a baby at 36 weeks via caesarean section, and was started on infliximab post partum. Surgery was deferred. Case 3: 32 year old G2P1 with Crohn's with enteroenteric fistula and fibrostenotic stricture at ileocecal valve presents at 17 weeks gestation with 1 week history of right upper quadrant pain, nausea and fevers requiring hospitalization. Both US and MRI showed 20cm segment of thick small bowel with mesenteric abscess. She had antibiotic therapy and urgent bowel resection with diverting loop ileostomy in a setting of septic shock. No further medical therapy was required during pregnancy. She delivered a healthy baby via elective caesarean at 38 weeks gestation. Conclusion: A multimodality approach to IBD patients in pregnancy allows for successful medical or surgical management and good outcomes for mother and baby. US and MRI are useful to assess disease severity and progression.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".