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Data on surgical management of complicated <jats:styled-content style=\"fixed-case\">IBD<\/jats:styled-content> in this setting are lacking. This study aimed to determine the optimal surgical strategy for medically refractory <jats:styled-content style=\"fixed-case\">IBD<\/jats:styled-content> during pregnancy and the puerperium.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Three databases were systematically reviewed to identify all published series or case reports of women undergoing surgery for Crohn's disease (<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>) or ulcerative colitis (<jats:styled-content style=\"fixed-case\">UC<\/jats:styled-content>) while pregnant or during the puerperium.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010two papers were identified, including 86 patients. Nearly one\u2010fifth (18%) of cases were <jats:italic>de novo<\/jats:italic> presentations and intervention was required at all stages of pregnancy. <jats:styled-content style=\"fixed-case\">UC<\/jats:styled-content> refractory to medical treatment and perforated small bowel <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content> were the commonest indications for surgery. Operations used included colectomy, colectomy with mucous fistula and Turnbull\u2010blowhole colostomy for complicated <jats:styled-content style=\"fixed-case\">UC<\/jats:styled-content> and open or laparoscopic small bowel resection with stoma formation for <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>. Surgical intervention during the third trimester universally resulted in the onset of labour. Endoscopic and radiological interventions were rarely employed. In studies after 1980 there was no maternal or foetal mortality but there was an almost 50% preterm delivery rate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Surgical management of complicated <jats:styled-content style=\"fixed-case\">IBD<\/jats:styled-content> during pregnancy and the puerperium needs to be tailored to disease severity, the type of complications and foetal status. 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