Patient Preferences for Vaginal Delivery Versus Cesarean Section After IPAA
Bibliographic record
Abstract
BACKGROUND: Women with ulcerative colitis or IBD unclassified are often diagnosed during their reproductive years. After proctocolectomy and reconstructive surgery with IPAA, the mode of delivery when giving birth is subject to ongoing debate. OBJECTIVE: To measure the amount of decreased pouch function and risk for pouch failure that women are willing to accept to deliver their child vaginally. DESIGN: Treatment tradeoff threshold study. SETTINGS: Participants were identified in the institutional database at Mount Sinai Hospital in Toronto, Canada. PATIENTS: Women aged between 18 to 49 years old who had previous surgery with IPAA for ulcerative colitis or IBD unclassified were asked to participate. INTERVENTIONS: All participants were subjected to a standardized interview. MAIN OUTCOME MEASURES: To measure the absolute increased risk for increased bowel frequency, urgency, incontinence, and pouch failure that participants were willing to accept to undergo vaginal delivery. RESULTS: A total of 49 participants (mean age, 36 [21-49] years) were included in the study. Twenty-five participants (51%) did not report any previous delivery. At baseline, 20% preferred cesarean section across all assessed outcomes. After vaginal delivery, a median increase of 2 bowel movements (baseline 5) per 24 hours was acceptable (median threshold: 8.0, interquartile range 6.0-9.0). For urgency, a 5-minute reduction from baseline 30 minutes was tolerated (median threshold: 20.0 minutes, interquartile range: 15.0-25.0). The median threshold for both liquid and solid fecal incontinence was 1 episode per month (baseline 0 episodes per month). The median risk threshold of pouch failure was 6.0% (interquartile range 6.0-9.5). Tolerance thresholds did not differ by delivery history. LIMITATIONS: Selection bias and biases inherent to the interview are possible. CONCLUSIONS: Women with IBD and IPAA are willing to accept a slight increase in bowel frequency and urgency to have a vaginal delivery. See Video Abstract . PREFERENCIAS DE LAS PACIENTES POR EL PARTO VAGINAL FRENTE A LA CESREA TRAS UNA ANASTOMOSIS ILEOANAL: ANTECEDENTES:Las mujeres con colitis ulcerosa o enfermedad inflamatoria intestinal no clasificada suelen ser diagnosticadas durante su edad fértil. Tras una proctocolectomía y una cirugía reconstructiva con anastomosis ileoanal, el modo de parto sigue siendo objeto de debate.OBJETIVO:Medir el grado de disminución de la función de la bolsa y el riesgo de fallo de la misma que las mujeres están dispuestas a aceptar para dar a luz por vía vaginal.DISEÑO:Estudio del umbral de compensación del tratamiento.ENTORNO:Las participantes fueron identificadas en la base de datos institucional del Hospital Mount Sinai de Toronto (Canadá).PACIENTES:Se pidió la participación de mujeres de entre 18 y 49 años que se habían sometido previamente a una cirugía con anastomosis ileoanal por colitis ulcerosa o enfermedad inflamatoria intestinal no clasificada.INTERVENCIONES:Todas las participantes fueron sometidas a una entrevista estandarizada.PRINCIPALES MEDIDAS DE RESULTADOS:Para medir el aumento absoluto del riesgo de aumento de la frecuencia intestinal, la urgencia, la incontinencia y el fallo de la bolsa, las participantes estaban dispuestas a aceptar someterse a un parto vaginal.RESULTADOS:Se incluyó en el estudio a un total de 49 participantes (edad media, 36 [21-49] años). Veinticinco (51 %) participantes no informaron de ningún parto anterior. Al inicio del estudio, el 20 % prefería la cesárea en todos los resultados evaluados. Tras el parto vaginal, se consideró aceptable un aumento medio de 2 deposiciones (valor inicial: 5) por cada 24 horas (umbral medio: 8,0, IQR 6,0-9,0). En cuanto a la urgencia, se toleró una reducción de 5 minutos con respecto a los 30 minutos iniciales (umbral medio: 20,0 minutos, IQR: 15,0-25,0). El umbral medio para la incontinencia fecal líquida y sólida fue de 1 episodio al mes (valor inicial: 0 episodios al mes). El umbral medio para el riesgo de fallo de la bolsa fue del 6,0 % (IQR: 6,0-9,5). Los umbrales de tolerancia no difirieron según el historial de partos.LIMITACIONES:Es posible que existan sesgos de selección y sesgos inherentes a la entrevista.CONCLUSIÓN:Las mujeres con enfermedad inflamatoria intestinal y anastomosis ileoanal están dispuestas a aceptar un ligero aumento de la frecuencia y la urgencia intestinal para tener un parto vaginal. ( AI-generated translation ).
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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 | 0.004 | 0.021 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
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".