Acute pancreatitis in pregnancy: meta-analysis of maternal and fetal outcomes

Abstract

The impact of acute pancreatitis in pregnancy on maternal and fetal outcomes is unclear. Historical case series document very poor outcomes, with maternal mortality rates of 20 per cent and fetal loss of 50 per cent. However, this is based on outdated clinical practice. This meta-analysis quantified both maternal and fetal outcomes following acute pancreatitis in pregnancy based on the concurrent literature. Maternal and fetal outcomes after acute pancreatitis in pregnancy have improved with advances in the management of pancreatitis.

Pancreatitis in Pregnancy—Comprehensive Review

“…Acute pancreatitis in pregnant women occurs with a frequency of 1/1000 to 1/5000 pregnancies [ 1 , 2 ]. Due to significant progress in the prevention, diagnosis, and proper treatment, the death rate of pregnant women due to AP, once very high (37%), has dropped to 3.3%, and fetal mortality from almost 60% to 11.6–18.7%, according to various reports [ 1 , 3 ]. The mean age of onset of AP in pregnancy was 28.5 years.…”

“…The same data were obtained for fetal deaths: the highest death rate was recorded in the first trimester (20.9%). Intrauterine fetal death was the most common in the third trimester (8.8%), while stillbirths were highest in the second trimester (6.2%) [ 3 ].…”

“…The effects of the disease on the fetus are related, on the one hand, to its course and, on the other hand, to the performed diagnosis or treatment. The consequence of the severe course of acute pancreatitis accompanied by SIRS may be the disruption of the functioning of the placenta, which may result in the death of the child [ 3 , 37 ]. On the other hand, diagnostics with the use of radiation, anesthesia, and pharmacotherapy may have a potentially harmful effect on the fetus.…”

Early predictive value of scoring systems and routine laboratory tests in severity and prognosis of acute pancreatitis in pregnancy

“…A recent meta-analysis demonstrated that the maternal mortality rate following APIP was reduced from 3.3% in 2010−2015 to 2.8% in 2016−2020 and the fetal mortality rate reduction was 12.6% from 13%. 1 Nonetheless, the fetal death rate secondary to APIP is still among the highest fetal mortality rates for surgical emergencies that may occur during pregnancy, compared to other pathologies, including 1.6% for simple appendicitis, 7% for non-operative management of cholecystitis, and 17% for small bowel obstruction. 2 – 4 APIP is more harmful to the fetus than to pregnant women.…”

Defined, low threshold for cesarean section and multidisciplinary team management improves fetal outcome from acute pancreatitis in pregnancy

“…Acute pancreatitis (AP) is a rare complication in pregnancy that causes signi cant maternal and fetal mortality, although estimates of the additional mortality from the combination of AP and pregnancy vary [1][2][3][4]. The incidence of AP in pregnancy (APIP) has been estimated at between 1 in 500 to 1 in 5,000 pregnancies [1,2,5], with a biliary etiology commonest in many series, and hypertriglyceridemia (HTG) commonest in China [4,5].…”