Annexe
QUESTIONNAIRE COHORTE MICI ET GROSSESSE
MICI :
- CROHN - RCH - INCLASSEE
NOMBRE DE GROSSESSE(S) :
DATES ET LIEUX DES ACCOUCHEMENTS :
- G1 : - G2 : - G3 : - G4 :
TRAITEMENT DE LA MICI AU MOMENT DES GROSSESSES : G1 G2 G3 G4 - PENTASA - FIVASA - IMUREL - INFLIXIMAB - ADALIMUMAB - ENTYVIO - STELARA
- AUTRE Si autre lequel ? :
CLASSIFICATION DE MONTREAL LORS DE LA GROSSESSE :
CROHN G1 G2 G3 G4 RCH G1 G2 G3 G4
L1 (iléon +/- caecum) E1 (proctite)
L2 (colon seul) E2 (colite gauche)
L3 (iléon + colon) E3 (colite étendue)
L4 (tube digestif haut) S0 (rémission)
B1 (inflamatoire) S1 (activité légère)
B2 (sténosante) S2 (activité modérée)
B3 (fistulisante) S3 (activité sévère)
P (atteinte périnéale) G1 G2 G3 G4 Terme (SA) Césarienne Forceps Episiotomie Poids de naissance Allaitement
SI ALLAITEMENT TRAITEMENT(S) EN COURS PENDANT CELUI-CI : PROBLEME(S) DE SANTE CHEZ LES ENFANTS :
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