Hypertriglyceridaemia-induced pancreatitis in pregnancy

Abstract

Introduction Acute pancreatitis (AP) is a recognised rare complication in pregnancy. The reported incidence varies between 1 in 1,500 to 3 in 10,000 pregnancies and is higher in the third trimester.1 The commonest causes in pregnancy include gallstones, alcohol and hypertriglyceridaemia.1 2 Non-gallstone pancreatitis is associated with more complications and worse outcome1 2 with hypertriglyceridaemia-induced AP having mortality rates ranging from 7.5-9.0% and 10.0-17.5% for mother and fetus, respectively.3 4 Case History A 40-year-old, para 4 woman presented with epigastric pain and vomiting at 15+4 weeks' gestation. She was admitted with AP secondary to hypertriglyceridaemia in June and discontinued fenofibrate on discovering she was pregnant. Past medical history included Grave's disease with no risk factor for hypertriglyceridaemia. Initial investigations showed elevated amylase (475.0 u/l) and triglycerides (46.6 mmol/l). She was admitted to HDU for supportive management with antibiotics, sliding scale and parenteral nutrition commenced on day 8. Imaging revealed an inflamed pancreas without evidence of biliary obstruction/gallstones hence confirming the diagnosis of hypertriglyceridaemia-induced AP. Her laboratory tests gradually improved (triglyceride 5.2 mmol/l on day 17) but she required 2 units of blood for anaemia. Fetal heart was auscultated regularly, however, on day 18 ultrasound confirmed fetal demise (18+1 weeks) and a hysterotomy was performed as she had had 4 previous caesarean sections. Conclusion Management of AP in pregnancy requires a multi-disciplinary approach. Hypertriglyceridaemia-induced AP has poor outcomes when diagnosed in early pregnancy. Identifying those at risk pre- and antenatally can allow close monitoring through pregnancy to optimise care.