Acute Pancreatitis in Pregnancy: A 2-year Experience at a Tertiary Care Center
Sharanya Hemant, Preet Agarwal, KS Rajeswari
Keywords :
Diagnosis, Pancreatitis in pregnancy, Treatment
Citation Information :
Hemant S, Agarwal P, Rajeswari K. Acute Pancreatitis in Pregnancy: A 2-year Experience at a Tertiary Care Center. J South Asian Feder Obs Gynae 2024; 16 (3):209-213.
Aim: To present a 2-year experience of acute pancreatitis in pregnancy in our institution.
Background: Acute pancreatitis during pregnancy is a rare event with incidence, ranging from 1:1,000 to 1:10,000. Biliary tract diseases are the most common cause of acute pancreatitis in pregnancy, with gallstone disease being responsible for more than 70% of cases. Gallstone formation during pregnancy is attributed to the lithogenic effect of pregnancy through estrogen and progesterone.
Results: Seven pregnant women with clinical and biochemical diagnosis of acute pancreatitis were studied. The mean gestational age of presentation was 28 weeks, The most common presenting complaint was the upper abdominal pain with vomiting (72%). The maximum amylase level was observed to be 2696 IU/L and the maximum lipase level was 4788 IU/L showing the condition hypertriglyceridemia with the maximum level 757 mg/dL) (28%). One patient had hypocalcemia (5.7 mg/dL) (14%). Six of the seven patients had leukocytosis maximum 22,400/cmm. The corticosteroid-binding globulin (CBG) levels of all patients were normal. The liver function tests (LFTs) of all patients were normal. Three patients had USG features of gallbladder sludge, one patient had gallstones. Three patients required ICU admissions. One patient (14%) had late phase symptoms at 29 weeks gestation requiring UGI Scopy TPN, IV octreotide. Two patients (28%) had moderately severe acute pancreatitis (according to revised Atlanta classification).
Clinical significance: It mimics the symptoms of acute fatty liver of pregnancy (AFLP), preeclampsia/hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, and GERD. Hence a thorough understanding of the presentation and differences in management of each condition is required to reduce significant maternal morbidity.
Conclusion: Acute pancreatitis in pregnancy is associated with significant maternal morbidity. Early diagnosis, classifying the severity of disease and treatment with multidisciplinary approach was the gold standard treatment.
Pitchumoni CS, Yegneswaran B. Acute pancreatitis in pregnancy. World J Gastroenterol 2009;15(45):5641–5646. DOI: 10.3748/wjg.15.5641.
Ramin KD, Ramin SM, Richey SD, et al. Acute pancreatitis in pregnancy. Amer J Obstet Gynecol 1995; 173(1):187–191. DOI: 10.1016/0002-9378(95)90188-4.
Ko CW, Beresford SA, Schulte SJ, et al. Incidence, natural history, and risk factors for biliary sludge and stones during pregnancy. Hepatology 2005;41(2):359–365. DOI: 10.1002/hep.20534.
Qihui C, Xiping Z, Xianfeng D. Clinical study on acute pancreatitis in pregnancy in 26 cases. Gastroenterol Res Pract 2012;2012:271925. DOI: 10.1155/2012/271925.
Stimac D, Stimac T. Acute pancreatitis during pregnancy. Eur J Gastroenterol Hepatol 2011;23(10):839–844. DOI: 10.1097/MEG.0b013e328349b199.
Juneja SK, Gupta S, Virk SS, et al. Acute pancreatitis in pregnancy: a treatment paradigm based on our hospital experience. Int J Appl Basic Med Res 2013;3(2):122–125. DOI: 10.4103/2229-516X.117090.
Uhl W, Anghelacopoulos SE, Friess H, et al. The role of octreotide and somatostatin in acute and chronic pancreatitis. Digestion 1999; 60 Suppl 2:23–31. DOI: 10.1159/000051477.
Fields K, Barkin J. Pancreatic disease. In: Gleicher N, editor. Principles and Practice of Medical Therapy in Pregnancy. Stamford (CT): Appleton and Lange; 1998. pp. 1142–1147.
Parmar MS. Pancreatic necrosis associated with pre-eclampsia and eclampsia. JOP 2004;5:101–104. PMID: 15007192.
Ntzeros K, Fragiadakis I, Stamatakos M. Open J Obstet Gynecol 2014;4:81–89. DOI: 10.4236/ojog.2014.42015.
Kim JY, Jung SH, Choi HW, et al. Acute idiopathic pancreatitis in pregnancy: A case study. World J Gastroenterol 2014;20(43):16364–16367. DOI: 10.3748/wjg.v20.i43.16364.
Sahu S, Raghuvanshi S, Bahl DV, et al. Acute pancreatitis in pregnancy. Int J Surg 2006;11(2):331–335.
Tenner S, Baillie J, DeWitt J, et al. American College of Gastroenterology guideline: management of acute pancreatitis. Amer J Gastroenterol 2013;108:1400–1415. DOI: 10.1038/ajg.2013.218.
Akcakaya A, Ozkan OV, Okan I, et al. Endoscopic retrograde cholangiopancreatography during pregnancy without radiation. World J Gastroenterol 2009;15:3649–3652. DOI: 10.3748/wjg.15.3649.
Sun Y, Fan C, Wang S. Clinical analysis of 16 patients with acute pancreatitis in the third trimester of pregnancy. Int J Clin Exp Pathol 2013;6:1696–1701. PMID: 23923092.
Esmer AÇ, Özsürmeli M, Kalelioğlu İ. Maternal and perinatal outcomes of acute pancreatitis during pregnancy. Gazi Med J 2012;23:133–137. DOI: 10.5152/gmj.2012.31.
Crisan LS, Steidl ET, Rivera-Alsina ME Acute hyperlipidemic pancreatitis in pregnancy. Am J Obstet Gynecol 2008;198(5):e57–e59. DOI: 10.1016/j.ajog.2008.01.003.
Jyothi GS, Bhoosanoor SR, Swarup A. Acute pancreatitis in pregnancy: Maternal Fetal Outcomes Journal of South Asian Federation of Obstetrics and Gynaecology 2017;9(2):100–103. DOI: 10.5005/jp-journals-10006-1469.
