Clinical characteristics of acute pancreatitis in pregnancy: experience based on 121 cases

Abstract

PurposeAcute pancreatitis in pregnancy (APIP) is a rare condition; however, it markedly affects maternal and fetal health. This study aimed to describe the types, clinical characteristics, mortality, and the safety and necessity of gestation termination of acute pancreatitis in pregnancy (APIP).MethodsWe retrospectively reviewed 121 APIP cases in the Gastroenterology Department of The First Affiliated Hospital of Nanchang University. APIP diagnosis were based on 2012 Atlanta Criteria. The correlation between APIP types, severity, biochemical parameters and mortality was analyzed.ResultsThe most common symptoms for APIP were abdominal pain (86.8%) and vomiting (73.6%). The most common causes for APIP were gallstone (36.4%) and hypertriglyceridemia (32.2%) and hypertriglyceridemic APIP was correlated with a higher rate for local complication (P = 0.012). Serum calcium level was negatively correlated with the severity of APIP (P < 0.01). The overall maternal and fetal mortality rate were 3.3% (4/121) and 11.6% (14/121), respectively. The severity of APIP was significantly correlated with higher risks for maternal and fetal death (P < 0.01). 72.7% of moderate-to-severe APIP patients underwent Cesarean section to terminate gestation safely.ConclusionThe most common causes of APIP were gallstone and hypertriglyceridemia. Lower level of serum calcium could be used as an indicator for the severity of the APIP. The severity of APIP was associated with higher risk for neonate asphyxia, and maternal and fetal death.

Hypertriglyceridemia triggered acute pancreatitis in pregnancy – diagnostic approach, management and follow-up care

“…Counseling and consent of the couple are mandatory. Confirmed stillbirth, the mandatory use of fetotoxic medication for pancreatitis treatment or organ failure are indications of termination of pregnancy, regardless if requires a term/preterm natural delivery or cesarean section [7]. Pregnancy termination can be regarded as a necessary condition to achieve AP cure [39].…”

“…The majority of cases occur in the third trimester or early postpartum and carry an increased maternal and fetal morbidity and mortality potential [4]. Maternal death rate due to pancreatitis was reportedly 37% and fetal death rate 60%, in decline recently as a result of more advanced diagnostic and therapeutic possibilities [5][6][7]. Pregnancy associated pancreatitis may occur on the background of gallstone disease, alcohol abuse and hypertriglyceridemia (HTG) [8][9][10].…”

“…Pregnancy associated pancreatitis may occur on the background of gallstone disease, alcohol abuse and hypertriglyceridemia (HTG) [8][9][10]. It appears that HTG aggravates the severity score and prognosis of disease [7,11,12].…”

Features of the Synthesis of Cytokines and Placental Dysfunction in Pregnant Women With Acute Pancreatitis

“…Частота самопроизвольных выкидышей в группе сравне-ния составила 11,9%, неразвивающейся беременности -29,8%, преждевременных родов -60,7%. Полученные данные о высокой частоте потерь беременности и антенатальной гибели плода при возникновении ОП согласуются с мнением большинства исследователей [9,18,25].…”

“…Трудности диагностики ОП при беременности обусловлены вариабельностью клинической симптоматики, идентичностью ее другим острым хирургическим нозологиям и акушерской патологии, несвоевременностью обращения женщин за медицинской помощью и зачастую непрофильной госпитализацией, способствуя удлинению времени начала патогенетической терапии и увеличивая риск развития акушерских осложнений [6,8,19,28]. По данным литературы, показатель материнской смертности при ОП варьирует от 12,5 до 39% (у небеременных -3-6%), а перинатальной -от 33,9 до 380‰ [1,20,23,25].…”