Mount Sinai Beth Israel Medical Center New York, NY, United States
Gres Karim, MD1, Michelle Shah, DO1, Dewan Giri, MBBS1, Neelesh Rastogi, MD2, Abhik Bhattacharya, MD3 1Mount Sinai Beth Israel Medical Center, New York, NY; 2Mount Sinai Morningside and Mount Sinai West/Mount Sinai Beth Israel Medical Center, New York, NY; 3Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY
Introduction: Pregnancy has not been associated with an increased risk of ulcerative colitis (UC) flares in patients with quiescent disease at conception. Flares are most common in the 1st trimester and in pregnant patients with active disease prior to conception. The etiology may be due to placental cytokine secretion or under-treatment before pregnancy. There is little data regarding the severity and treatment of flares in pregnancy. We present a rare case of a G1P0 with prior remission of UC, on mesalamine maintenance therapy, who presented in her 3rd trimester with acute severe UC flare, unresponsive to medical treatment, requiring emergent subtotal colectomy with cesarean delivery due to fetal distress.
Case Description/Methods: A 32-year-old female G1P0, at 31 weeks gestation, with a history of pancolitis secondary to UC, in clinical remission on mesalamine maintenance, presented with ten days of bloody diarrhea, abdominal pain, and decreased oral intake secondary to nausea and vomiting. She endorsed up to 20 bloody bowel movements daily and 12-pound weight loss. She had failed outpatient therapy with prednisone. She presented with an albumin of 1.6 and profound anemia. Upon admission, she received several units of packed RBCs and was initiated on methylprednisolone. She failed to improve on steroid therapy and a decision was made for infliximab induction, with accelerated 10 mg/kg dosing. Despite therapy, she continued to experience bouts of bloody diarrhea and subsequently developed recurrent tachycardia and resultant fetal bradycardia. Given her condition and the non-reassuring fetal heart rate, urgent subtotal colectomy with end ileostomy and concurrent cesarean section was performed at 32 weeks, 1 day. The patient and neonate tolerated the procedure well and were in stable condition postoperatively.
Discussion: UC has a peak age of incidence coinciding with fertility in female patients, making its diagnosis and treatment crucial. Pregnant women with UC have an increased risk of antepartum hemorrhage, low birth weight infants, and premature delivery. Close monitoring in pregnancy is important to ensure proper early treatment and favorable outcomes. Remission achieved during pregnancy usually remains throughout pregnancy and relapse rates are lower up to ten years thereafter. More formalized studies regarding the treatment of UC flares during pregnancy should be performed. Our case demonstrates that favorable outcomes are possible for severe flares requiring surgical intervention during pregnancy.
Disclosures: Gres Karim indicated no relevant financial relationships. Michelle Shah indicated no relevant financial relationships. Dewan Giri indicated no relevant financial relationships. Neelesh Rastogi indicated no relevant financial relationships. Abhik Bhattacharya indicated no relevant financial relationships.
Gres Karim, MD1, Michelle Shah, DO1, Dewan Giri, MBBS1, Neelesh Rastogi, MD2, Abhik Bhattacharya, MD3. P2720 - An Acute Severe Ulcerative Colitis Flare in Pregnancy Requiring Emergent Subtotal Colectomy and Concurrent Cesarean Delivery, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.