Acute Pancreatitis in Pregnancy

Objective. The highest maternal-fetal risk from pancreatitis in pregnancy is likely to be posed by the most severe cases, which we have compared with mild cases. Design. Retrospective observational study. Setting. A general surgery department of a university referral hospital in Nanjing, China. Population. Eighteen pregnancies complicated with severe acute pancreatitis and 51 pregnancies complicated with mild acute pancreatitis. Methods. Medical records were reviewed for every pregnant woman with mild or severe acute pancreatitis during January 1999 to December 2009. Main Outcome Measures. Information on demographics, clinical and laboratory data, maternal and fetal outcomes. Results. Gestational age of onset was significantly higher in the severe acute pancreatitis group than in the mild acute pancreatitis group. Severe hypertriglyceridemia was considered the main cause of severe acute pancreatitis (OR 20.7; 95% CI 4.6-92.4, p<0.001), while biliary disease contributed to the etiology of mild acute pancreatitis (OR 7.3; 95% CI 1.8-30.1, p<0.01). Abortions and preterm infants contributed to fetal loss in the mild group, while fetal death and stillbirth contributed in the severe group. Conclusions. Hyperlipidemic pancreatitis and biliary pancreatitis are the main causes of severe and mild disease, respectively. Severe acute pancreatitis in pregnancy usually occurs in the third trimester, and the affected severe patients are more liable to develop a critical condition that results in higher risk of intrauterine fetal death.