Acute pancreatitis in pregnancy: an overview

Papadakis, Efstathios; Sarigianni, Maria; Mikhailidis, Dimitri P.; Mamopoulos, Apostolos; Karagiannis, Vasilios

doi:10.1016/j.ejogrb.2011.07.037

Cited by 89 publications

(83 citation statements)

References 91 publications

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“…Increased TG levels can be notably high independent of ART use. 29,30 An increase in ALT levels was rarely observed in the present study. One patient using the increased dose presented with hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome during her pregnancy.…”

Section: Changes In Laboratory Testsmentioning

confidence: 57%

A Randomized Controlled Trial to Assess Safety, Tolerability, and Antepartum Viral Load with Increased Lopinavir/Ritonavir Dosage in Pregnancy

Bonafé

Costa

Vaz

et al. 2013

AIDS Patient Care and STDs

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HIV mother-to-child transmission (MTCT) is significantly reduced if antepartum viral load (apVL) is < 50 copies/mL. Pharmacokinetic studies suggest increasing the dosage of lopinavir/ritonavir (LPV/r) in pregnancy. It is important to assess tolerance, safety, and rate of patients presenting a apVL < 50 copies/mL when treating with increased dose of LPV/r during pregnancy. Confirmed HIV-infected pregnant women with a fetus at a gestational age of 14-33 weeks were randomly assigned to receive LPV/r 400/100 or 600/150 mg b.i.d. plus two nucleoside analogues (NRTIs). Treatment was discontinued in the case of alanine transaminase (ALT) of grade III elevation or higher, glucose, or triglycerides. Thirty-two women were randomized to the LPV/r 400/ 100 mg dose, and 31 women were randomized to the 600/150 mg dose. Overall, 9.4% of the women receiving the conventional dose, and 17.2% receiving the increased dose, discontinued treatment because of adverse events ( p = 0.29). The rates of gastrointestinal (GI) symptoms, laboratory abnormalities, preterm delivery, and low birth weight were similar in both groups. There were no cases of HIV MTCT. Among the women with a baseline VL > 50 copies/mL assigned to the conventional dose group, 45% (95% confidence interval [CI] 62.5-27.5%) had a apVL > 50 copies/mL compared with 10.5% (95% CI 21.6-0.6%) of those assigned to the increased dose group ( p = 0.01). There was no significant difference found for the patients with a baseline VL < 50 copies/mL. In pregnant women with a baseline VL > 50 copies/mL, it may be warranted to initiate LPV/r dosing at 600/ 150 mg, whereas the conventional dose is sufficient for pregnant women with a baseline VL < 50 copies/mL.

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Section: Changes In Laboratory Testsmentioning

confidence: 57%

A Randomized Controlled Trial to Assess Safety, Tolerability, and Antepartum Viral Load with Increased Lopinavir/Ritonavir Dosage in Pregnancy

Bonafé

Costa

Vaz

et al. 2013

AIDS Patient Care and STDs

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“…Dyslipidemia usually occurs during the 3rd trimester of pregnancy and TG concentrations higher than 1000 mg/dL is observed in the cases with sever hyperlipidemia (1,2). Pancreatitis may also develop in patients with lower TG levels, such as the current study cases who developed pancreatitis with TG levels lower than 1000 mg/dL.…”

Section: Discussionmentioning

confidence: 96%

“…Increase in TG level is caused by 2 major reasons. First, increase in liver lipase enzyme activity, which results in increase of TG synthesis in liver; second, reduction in lipoprotein lipase activity, which by itself results in the reduction of fat tissue catabolism (1). High concentration of TG in mother provides enough substrate for fetus metabolism, when the blood glucose level is low.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Two Supplements on Gestational Hypertriglyceridemia: Report of Two Cases

Mirzaeean¹,

Pourhoseini²,

Esfahani³

et al. 2017

Women Health Bull

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Introduction: Hypertriglyceridemia (HTG) is a physiological condition of pregnancy. However, in some patients, it could be harmful due to possible complications such as pancreatitis. Treating this clinical condition during pregnancy is controversial as many drugs are not allowed in different trimesters. The current report discussed 2 cases of HTG and their outcomes during pregnancy. Case Presentation: The 1st patient had twin pregnancy and a "milky" blood sample raised suspicion on abnormal lipid profile (LP) during the pregnancy screening tests. There was a positive history of HTG and the available laboratory results showed triglyceride (TG) 3920 mg/dL, cholesterol (Chol) 1370 mg/dL, and normal amylase and lipase serum levels. The patient received daily LP and blood glucose monitoring as well as insulin, gemfibrozil, and fish oil prescription. In the 30th week of gestation, one of the fetuses was lost and a cesarean section, because of preterm uterine contractures, was performed. Mother and baby were discharged in good conditions. The 2nd patient presented with nausea, vomiting, and abdominal pain in the 22nd week of gestation. The patient had gestational diabetes without the history of HTG. Laboratory results were as follows: TG 878 mg/dL, Chol 249 mg/dL, amylase 251 U/L, and lipase 29 U/L. The patient was treated as pancreatitis induced by HTG. Therefore, gemfibrozil and fish oil were prescribed in addition to hydration and low fat diet. A healthy term baby was the result of pregnancy. Conclusions: Establishing prompt medical treatment and controlling comorbid conditions are essential in gestational HTG. Although there are controversial reports about using medications such as fibrates and fish oil, gemfibrozil and fish oil were recommended as an effective treatment for the patients with gestational HTG.

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“…16 The course of pancreatitis during pregnancy is usually mild and self-limited but can be rapidly progressive and fulminant due to severe complications such as pancreatic necrosis, generalized peritonitis, acute respiratory distress syndrome (ARDS), disseminated intravacular coagulopathy (DIC) and multiple organ failure. 17 According to the Atlanta classification, severe AP is defined by the presence of local complications and/or organ failure (shock, pulmonary insufficiency, and renal failure Organ failure develops often early in the course of AP. 18 The revised Atlanta classification also outlines other important findings to be evaluated with imaging such as causes of pancreatitis, including cholecystolithiasis and choledocholithiasis, or complications related to acute pancreatitis, including extrahepatic biliary dilatation; splenic, portal, and mesenteric venous thrombosis, varices; arterial pseudoaneurysm; pleural effusion; and ascites.…”

mentioning

confidence: 99%

Acute pancreatitis in pregnancy: 5-year experience from a multidisciplinary centre

Srikumar

Nair

Reghunath

et al. 2018

Int J Reprod Contracept Obstet Gynecol

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Background: Acute pancreatitis is rare in pregnancy, but it is associated with increased incidence of maternal and fetal mortality. It should be one of the differential diagnosis of upper abdominal pain with or without nausea or vomiting. S. amylase, lipase and ultrasound abdomen were the diagnostic methods. Conservative management is the main stay in mild cases. Severe cases have multiorgan involvement and needs multidisciplinary approach. The objectives of this study were to study the maternal and fetal outcome in pregnant women diagnosed with acute pancreatitis and to identify the risk factors for acute pancreatitis in pregnancy.Methods: Retrospective descriptive study of pregnant women diagnosed with acute pancreatitis in Amrita Institute of Medical Sciences, Kochi during the period of 5 years from January 2011 to December 2016. A proforma having patients age, parity index, gestational age, symptoms with duration, blood investigations, ultrasonography, interventions done, mode of delivery, supportive treatment, complications were developed. Fetal weight, Apgar score, fetal complications were also noted.Results: The mean gestational age of presentation was 30 weeks of pregnancy. Upper abdominal pain radiating to back, vomiting, fever was the commonest clinical presentation in majority of cases. The diagnostic methods were S.Amylase ,Lipase and Ultrasound abdomen. The mean age of the patients were 26 years and 66.7% were primigravidas in the present study. There were 4 patients in SAP and 5 in MAP groups. Complications in SAP group were ARF, ARDS, DIC, MODS, metabolic acidosis etc. SAP group had 3 maternal and 3 fetal loss.Conclusions: Severe acute pancreatitis has adverse maternal and fetal outcome due to multi organ failure and sepsis.

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Acute pancreatitis in pregnancy: an overview

Cited by 89 publications

References 91 publications

A Randomized Controlled Trial to Assess Safety, Tolerability, and Antepartum Viral Load with Increased Lopinavir/Ritonavir Dosage in Pregnancy

A Randomized Controlled Trial to Assess Safety, Tolerability, and Antepartum Viral Load with Increased Lopinavir/Ritonavir Dosage in Pregnancy

Effect of Two Supplements on Gestational Hypertriglyceridemia: Report of Two Cases

Acute pancreatitis in pregnancy: 5-year experience from a multidisciplinary centre

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