| . | Topic 1 . | Topic 2 . | Topic 3 . | Topic 4 . | Topic 5 . |
|---|---|---|---|---|---|
| Scenario 1 (Maximum score 25) Diana is a 26 year old woman with a 10 year history of ileocolonic and perianal CD. She has been on Infliximab monotherapy for 3 years and has good trough levels with no anti-drug antibodies. Her last examination under anaesthesia was 2 years ago when an abscess was treated. A seton remains in situ. She is now 22 weeks pregnant and reports feeling well. There is no abdominal pain, she opens her bowels twice daily and reports no pain or discharge from her perineum. She is already under a consultant led obstetric clinic. | Anti TNF use in 3rdtrimester pregnancy • Drug treatment (1) • Infliximab low risk, discuss 3rd trimester plan (3) • Clear advice to continue/stop Infliximab in 3rd trimester (5) | Delivery considerations in perianal CD • Delivery mentioned (1) • Advice specifically on mode of delivery (3) • Advises caesarean birth mandatory in this scenario (5) | Neonatal vaccinations with biologic use • Childhood vaccinations (1) • Advises avoid or delay live vaccinations (3) • Avoid or delay live vaccinations; specifically mentions rotavirus and/or BCG vaccination (5) | Breastfeeding considerations • Breastfeeding (1) • Breastfeeding safe while on Infliximab (3) • Breastfeeding safe and offers advantages over bottle feeding (5) | Other considerations (1 point each, up to maximum 5 points if good rationale) • Growth scanning • VTE prophylaxis • IBD advice line • Risk of postpartum flare • Early postpartum follow-up • Infliximab plan postpartum • Inheritance of IBD |
| Scenario 2 (Maximum score 20) Abby is a 35-year old woman who is 28 weeks into her first pregnancy. Abby has a family history of type 2 diabetes, a BMI of 35 and a background of left sided UC that was previously well controlled. She has been flaring for 4 weeks with a FC > 1000. On advice by the advice line she has increased her mesalazine from 2.4g OD to 2.4g BD and added in mesalazine 2g liquid enemas. This has not improved her symptoms much. She opens her bowel 6/day (normal for her 2/day) and sees blood with every 2nd motion. She has no tachycardia or fever. You have commenced her on Prednisolone 40mg reducing over 8 weeks. She is under the care of a community midwife. | Considerations when managing UC flare during pregnancy • IBD treatment and observation (1) • Ensure she contacts IBD services if not improving (3) • Arrange close follow-up to ensure quick clinical improvement (5) | Obstetric considerations (maximum 5 points if all mentioned) • Needs obstetric clinic/ obstetric led care (1) • Risk of pre-eclampsia (1) • Growth scan required (3) • Risk of gestational diabetes (3) | VTE risk • VTE risk mentioned (1) • Discuss VTE risk with obstetrician (3) • Needs VTE prophylaxis as several risk factors (5) | Other considerations (1 point each, up to maximum 5 points if good rationale) • Further pregnancy care • Advice on drug safety and importance • Can have vaginal delivery obstetric course permitting • Breastfeeding advice • Risk of postpartum flare • Vaccination advice | |
| Scenario 3 (Maximum score 25) Samantha is a 28 year old woman with ileo-colonic CD. She has required 2 resections including a panproctocolectomy and a further ileal resection. She has an ileostomy at present and her last imaging 6 months ago showed 20 cms of ileal inflammation leading up to the stoma. She started adalimumab 40mg 6 months ago and feels well. She reports stopping her adalimumab after she found she is pregnant 3 weeks ago. She is seen in IBD clinic by yourself and has yet to see obstetric services. She believes she is 15 weeks pregnant. Samantha says she will only consider a caesarean birth. | Risk of active disease during pregnancy, optimizing disease control • Importance of remission and drug therapy (1) • Advises adalimumab low risk in pregnancy (3) • Advises patient is high risk for active symptoms due to known active CD and risk of CD > risk from adalimumab, advises strongly to continue, assess disease activity eg. FC (5) | Anti TNF use during pregnancy • Management of adalimumab (1) • Advises on whether to stop or continue (3) • Vaccination advice, and clear advice to continue adalimumab (5) | Obstetric considerations in active IBD • Refer for obstetric care (1) • Needs “delayed” 12 week scan and obstetric clinic asap (3) [does not need to specifically state’12 week scan’ as long as they recognize pregnancy is high risk] Needs 3rd trimester growth scans (5) | Delivery considerations in non-perianal CD • Mode of delivery discussion (1) • Recognizes that CD intervention is not indication for caesarean birth (3) • Discuss benefits and risks of caesarean in patients, with suggestion towards vaginal delivery (5) | Other considerations (1 point each, up to 5 if good rationale) • Breastfeeding advice • VTE advice • When to start adalimumab after delivery (assuming it was stopped) • Stoma issues including change of shape, how to deal with potential stoma problems (obstruction, prolapse) • Nutritional considerations |
| . | Topic 1 . | Topic 2 . | Topic 3 . | Topic 4 . | Topic 5 . |
|---|---|---|---|---|---|
| Scenario 1 (Maximum score 25) Diana is a 26 year old woman with a 10 year history of ileocolonic and perianal CD. She has been on Infliximab monotherapy for 3 years and has good trough levels with no anti-drug antibodies. Her last examination under anaesthesia was 2 years ago when an abscess was treated. A seton remains in situ. She is now 22 weeks pregnant and reports feeling well. There is no abdominal pain, she opens her bowels twice daily and reports no pain or discharge from her perineum. She is already under a consultant led obstetric clinic. | Anti TNF use in 3rdtrimester pregnancy • Drug treatment (1) • Infliximab low risk, discuss 3rd trimester plan (3) • Clear advice to continue/stop Infliximab in 3rd trimester (5) | Delivery considerations in perianal CD • Delivery mentioned (1) • Advice specifically on mode of delivery (3) • Advises caesarean birth mandatory in this scenario (5) | Neonatal vaccinations with biologic use • Childhood vaccinations (1) • Advises avoid or delay live vaccinations (3) • Avoid or delay live vaccinations; specifically mentions rotavirus and/or BCG vaccination (5) | Breastfeeding considerations • Breastfeeding (1) • Breastfeeding safe while on Infliximab (3) • Breastfeeding safe and offers advantages over bottle feeding (5) | Other considerations (1 point each, up to maximum 5 points if good rationale) • Growth scanning • VTE prophylaxis • IBD advice line • Risk of postpartum flare • Early postpartum follow-up • Infliximab plan postpartum • Inheritance of IBD |
| Scenario 2 (Maximum score 20) Abby is a 35-year old woman who is 28 weeks into her first pregnancy. Abby has a family history of type 2 diabetes, a BMI of 35 and a background of left sided UC that was previously well controlled. She has been flaring for 4 weeks with a FC > 1000. On advice by the advice line she has increased her mesalazine from 2.4g OD to 2.4g BD and added in mesalazine 2g liquid enemas. This has not improved her symptoms much. She opens her bowel 6/day (normal for her 2/day) and sees blood with every 2nd motion. She has no tachycardia or fever. You have commenced her on Prednisolone 40mg reducing over 8 weeks. She is under the care of a community midwife. | Considerations when managing UC flare during pregnancy • IBD treatment and observation (1) • Ensure she contacts IBD services if not improving (3) • Arrange close follow-up to ensure quick clinical improvement (5) | Obstetric considerations (maximum 5 points if all mentioned) • Needs obstetric clinic/ obstetric led care (1) • Risk of pre-eclampsia (1) • Growth scan required (3) • Risk of gestational diabetes (3) | VTE risk • VTE risk mentioned (1) • Discuss VTE risk with obstetrician (3) • Needs VTE prophylaxis as several risk factors (5) | Other considerations (1 point each, up to maximum 5 points if good rationale) • Further pregnancy care • Advice on drug safety and importance • Can have vaginal delivery obstetric course permitting • Breastfeeding advice • Risk of postpartum flare • Vaccination advice | |
| Scenario 3 (Maximum score 25) Samantha is a 28 year old woman with ileo-colonic CD. She has required 2 resections including a panproctocolectomy and a further ileal resection. She has an ileostomy at present and her last imaging 6 months ago showed 20 cms of ileal inflammation leading up to the stoma. She started adalimumab 40mg 6 months ago and feels well. She reports stopping her adalimumab after she found she is pregnant 3 weeks ago. She is seen in IBD clinic by yourself and has yet to see obstetric services. She believes she is 15 weeks pregnant. Samantha says she will only consider a caesarean birth. | Risk of active disease during pregnancy, optimizing disease control • Importance of remission and drug therapy (1) • Advises adalimumab low risk in pregnancy (3) • Advises patient is high risk for active symptoms due to known active CD and risk of CD > risk from adalimumab, advises strongly to continue, assess disease activity eg. FC (5) | Anti TNF use during pregnancy • Management of adalimumab (1) • Advises on whether to stop or continue (3) • Vaccination advice, and clear advice to continue adalimumab (5) | Obstetric considerations in active IBD • Refer for obstetric care (1) • Needs “delayed” 12 week scan and obstetric clinic asap (3) [does not need to specifically state’12 week scan’ as long as they recognize pregnancy is high risk] Needs 3rd trimester growth scans (5) | Delivery considerations in non-perianal CD • Mode of delivery discussion (1) • Recognizes that CD intervention is not indication for caesarean birth (3) • Discuss benefits and risks of caesarean in patients, with suggestion towards vaginal delivery (5) | Other considerations (1 point each, up to 5 if good rationale) • Breastfeeding advice • VTE advice • When to start adalimumab after delivery (assuming it was stopped) • Stoma issues including change of shape, how to deal with potential stoma problems (obstruction, prolapse) • Nutritional considerations |
Abbreviations: CD, Crohn’s disease; TNF, tumor necrosis factor; VTE, venous thromboembolism; BMI, body mass index; UC, ulcerative colitis; FC, fecal calprotectin; OD, once daily; BD, twice daily.
Number of points awarded in parentheses after each topic and criteria listed.
| . | Topic 1 . | Topic 2 . | Topic 3 . | Topic 4 . | Topic 5 . |
|---|---|---|---|---|---|
| Scenario 1 (Maximum score 25) Diana is a 26 year old woman with a 10 year history of ileocolonic and perianal CD. She has been on Infliximab monotherapy for 3 years and has good trough levels with no anti-drug antibodies. Her last examination under anaesthesia was 2 years ago when an abscess was treated. A seton remains in situ. She is now 22 weeks pregnant and reports feeling well. There is no abdominal pain, she opens her bowels twice daily and reports no pain or discharge from her perineum. She is already under a consultant led obstetric clinic. | Anti TNF use in 3rdtrimester pregnancy • Drug treatment (1) • Infliximab low risk, discuss 3rd trimester plan (3) • Clear advice to continue/stop Infliximab in 3rd trimester (5) | Delivery considerations in perianal CD • Delivery mentioned (1) • Advice specifically on mode of delivery (3) • Advises caesarean birth mandatory in this scenario (5) | Neonatal vaccinations with biologic use • Childhood vaccinations (1) • Advises avoid or delay live vaccinations (3) • Avoid or delay live vaccinations; specifically mentions rotavirus and/or BCG vaccination (5) | Breastfeeding considerations • Breastfeeding (1) • Breastfeeding safe while on Infliximab (3) • Breastfeeding safe and offers advantages over bottle feeding (5) | Other considerations (1 point each, up to maximum 5 points if good rationale) • Growth scanning • VTE prophylaxis • IBD advice line • Risk of postpartum flare • Early postpartum follow-up • Infliximab plan postpartum • Inheritance of IBD |
| Scenario 2 (Maximum score 20) Abby is a 35-year old woman who is 28 weeks into her first pregnancy. Abby has a family history of type 2 diabetes, a BMI of 35 and a background of left sided UC that was previously well controlled. She has been flaring for 4 weeks with a FC > 1000. On advice by the advice line she has increased her mesalazine from 2.4g OD to 2.4g BD and added in mesalazine 2g liquid enemas. This has not improved her symptoms much. She opens her bowel 6/day (normal for her 2/day) and sees blood with every 2nd motion. She has no tachycardia or fever. You have commenced her on Prednisolone 40mg reducing over 8 weeks. She is under the care of a community midwife. | Considerations when managing UC flare during pregnancy • IBD treatment and observation (1) • Ensure she contacts IBD services if not improving (3) • Arrange close follow-up to ensure quick clinical improvement (5) | Obstetric considerations (maximum 5 points if all mentioned) • Needs obstetric clinic/ obstetric led care (1) • Risk of pre-eclampsia (1) • Growth scan required (3) • Risk of gestational diabetes (3) | VTE risk • VTE risk mentioned (1) • Discuss VTE risk with obstetrician (3) • Needs VTE prophylaxis as several risk factors (5) | Other considerations (1 point each, up to maximum 5 points if good rationale) • Further pregnancy care • Advice on drug safety and importance • Can have vaginal delivery obstetric course permitting • Breastfeeding advice • Risk of postpartum flare • Vaccination advice | |
| Scenario 3 (Maximum score 25) Samantha is a 28 year old woman with ileo-colonic CD. She has required 2 resections including a panproctocolectomy and a further ileal resection. She has an ileostomy at present and her last imaging 6 months ago showed 20 cms of ileal inflammation leading up to the stoma. She started adalimumab 40mg 6 months ago and feels well. She reports stopping her adalimumab after she found she is pregnant 3 weeks ago. She is seen in IBD clinic by yourself and has yet to see obstetric services. She believes she is 15 weeks pregnant. Samantha says she will only consider a caesarean birth. | Risk of active disease during pregnancy, optimizing disease control • Importance of remission and drug therapy (1) • Advises adalimumab low risk in pregnancy (3) • Advises patient is high risk for active symptoms due to known active CD and risk of CD > risk from adalimumab, advises strongly to continue, assess disease activity eg. FC (5) | Anti TNF use during pregnancy • Management of adalimumab (1) • Advises on whether to stop or continue (3) • Vaccination advice, and clear advice to continue adalimumab (5) | Obstetric considerations in active IBD • Refer for obstetric care (1) • Needs “delayed” 12 week scan and obstetric clinic asap (3) [does not need to specifically state’12 week scan’ as long as they recognize pregnancy is high risk] Needs 3rd trimester growth scans (5) | Delivery considerations in non-perianal CD • Mode of delivery discussion (1) • Recognizes that CD intervention is not indication for caesarean birth (3) • Discuss benefits and risks of caesarean in patients, with suggestion towards vaginal delivery (5) | Other considerations (1 point each, up to 5 if good rationale) • Breastfeeding advice • VTE advice • When to start adalimumab after delivery (assuming it was stopped) • Stoma issues including change of shape, how to deal with potential stoma problems (obstruction, prolapse) • Nutritional considerations |
| . | Topic 1 . | Topic 2 . | Topic 3 . | Topic 4 . | Topic 5 . |
|---|---|---|---|---|---|
| Scenario 1 (Maximum score 25) Diana is a 26 year old woman with a 10 year history of ileocolonic and perianal CD. She has been on Infliximab monotherapy for 3 years and has good trough levels with no anti-drug antibodies. Her last examination under anaesthesia was 2 years ago when an abscess was treated. A seton remains in situ. She is now 22 weeks pregnant and reports feeling well. There is no abdominal pain, she opens her bowels twice daily and reports no pain or discharge from her perineum. She is already under a consultant led obstetric clinic. | Anti TNF use in 3rdtrimester pregnancy • Drug treatment (1) • Infliximab low risk, discuss 3rd trimester plan (3) • Clear advice to continue/stop Infliximab in 3rd trimester (5) | Delivery considerations in perianal CD • Delivery mentioned (1) • Advice specifically on mode of delivery (3) • Advises caesarean birth mandatory in this scenario (5) | Neonatal vaccinations with biologic use • Childhood vaccinations (1) • Advises avoid or delay live vaccinations (3) • Avoid or delay live vaccinations; specifically mentions rotavirus and/or BCG vaccination (5) | Breastfeeding considerations • Breastfeeding (1) • Breastfeeding safe while on Infliximab (3) • Breastfeeding safe and offers advantages over bottle feeding (5) | Other considerations (1 point each, up to maximum 5 points if good rationale) • Growth scanning • VTE prophylaxis • IBD advice line • Risk of postpartum flare • Early postpartum follow-up • Infliximab plan postpartum • Inheritance of IBD |
| Scenario 2 (Maximum score 20) Abby is a 35-year old woman who is 28 weeks into her first pregnancy. Abby has a family history of type 2 diabetes, a BMI of 35 and a background of left sided UC that was previously well controlled. She has been flaring for 4 weeks with a FC > 1000. On advice by the advice line she has increased her mesalazine from 2.4g OD to 2.4g BD and added in mesalazine 2g liquid enemas. This has not improved her symptoms much. She opens her bowel 6/day (normal for her 2/day) and sees blood with every 2nd motion. She has no tachycardia or fever. You have commenced her on Prednisolone 40mg reducing over 8 weeks. She is under the care of a community midwife. | Considerations when managing UC flare during pregnancy • IBD treatment and observation (1) • Ensure she contacts IBD services if not improving (3) • Arrange close follow-up to ensure quick clinical improvement (5) | Obstetric considerations (maximum 5 points if all mentioned) • Needs obstetric clinic/ obstetric led care (1) • Risk of pre-eclampsia (1) • Growth scan required (3) • Risk of gestational diabetes (3) | VTE risk • VTE risk mentioned (1) • Discuss VTE risk with obstetrician (3) • Needs VTE prophylaxis as several risk factors (5) | Other considerations (1 point each, up to maximum 5 points if good rationale) • Further pregnancy care • Advice on drug safety and importance • Can have vaginal delivery obstetric course permitting • Breastfeeding advice • Risk of postpartum flare • Vaccination advice | |
| Scenario 3 (Maximum score 25) Samantha is a 28 year old woman with ileo-colonic CD. She has required 2 resections including a panproctocolectomy and a further ileal resection. She has an ileostomy at present and her last imaging 6 months ago showed 20 cms of ileal inflammation leading up to the stoma. She started adalimumab 40mg 6 months ago and feels well. She reports stopping her adalimumab after she found she is pregnant 3 weeks ago. She is seen in IBD clinic by yourself and has yet to see obstetric services. She believes she is 15 weeks pregnant. Samantha says she will only consider a caesarean birth. | Risk of active disease during pregnancy, optimizing disease control • Importance of remission and drug therapy (1) • Advises adalimumab low risk in pregnancy (3) • Advises patient is high risk for active symptoms due to known active CD and risk of CD > risk from adalimumab, advises strongly to continue, assess disease activity eg. FC (5) | Anti TNF use during pregnancy • Management of adalimumab (1) • Advises on whether to stop or continue (3) • Vaccination advice, and clear advice to continue adalimumab (5) | Obstetric considerations in active IBD • Refer for obstetric care (1) • Needs “delayed” 12 week scan and obstetric clinic asap (3) [does not need to specifically state’12 week scan’ as long as they recognize pregnancy is high risk] Needs 3rd trimester growth scans (5) | Delivery considerations in non-perianal CD • Mode of delivery discussion (1) • Recognizes that CD intervention is not indication for caesarean birth (3) • Discuss benefits and risks of caesarean in patients, with suggestion towards vaginal delivery (5) | Other considerations (1 point each, up to 5 if good rationale) • Breastfeeding advice • VTE advice • When to start adalimumab after delivery (assuming it was stopped) • Stoma issues including change of shape, how to deal with potential stoma problems (obstruction, prolapse) • Nutritional considerations |
Abbreviations: CD, Crohn’s disease; TNF, tumor necrosis factor; VTE, venous thromboembolism; BMI, body mass index; UC, ulcerative colitis; FC, fecal calprotectin; OD, once daily; BD, twice daily.
Number of points awarded in parentheses after each topic and criteria listed.
This PDF is available to Subscribers Only
View Article Abstract & Purchase OptionsFor full access to this pdf, sign in to an existing account, or purchase an annual subscription.
