Original article—liver, pancreas, and biliary tract
Acute Pancreatitis During Pregnancy

https://doi.org/10.1016/j.cgh.2009.08.035Get rights and content

Background & Aims

Acute pancreatitis is rare during pregnancy; limited data are available about maternal and fetal outcomes. We investigated the effects of acute pancreatitis during pregnancy on fetal outcome.

Methods

This retrospective cohort study, performed at a single academic center, included consecutive pregnant women who presented with (n = 96) or developed acute pancreatitis in the hospital (n = 7) in 2000–2006 (mean age, 26 y). Patient histories and clinical data were collected from medical records.

Results

Of the 96 patients with spontaneous pancreatitis, 4 had complications: 1 patient in the first trimester had acute peripancreatic fluid collection, and 3 patients in the third trimester developed disseminated vascular coagulation (DIC). None of these patients achieved term pregnancy, and 1 of the patients with DIC died. Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 23 patients with acute pancreatitis; post-ERCP pancreatitis was diagnosed in 4 patients (a total of 11 patients developed ERCP-associated pancreatitis). Term pregnancy was achieved in 73 patients (80.2%). Patients who developed pancreatitis in the first trimester had the lowest percentage of term pregnancy (60%) and highest risks of fetal loss (20%) and preterm delivery (16%). Of the patients with pancreatitis in the second and third trimesters, only one had fetal loss. Fetal malformations were not observed.

Conclusions

The majority of pregnant patients with acute pancreatitis did not have complications; most adverse fetal outcomes (fetal loss and preterm delivery) occurred during the first trimester. Acute pancreatitis, complicated by DIC, occurred most frequently in the third trimester and was associated with poor fetal and maternal outcomes.

Section snippets

Patients

This was a retrospective study over a 6-year period (September 2000–September 2006) at PMH and was approved by the University of Texas Southwestern Medical Center Institutional Review Board. Through computerized diagnostic codes entered on discharge, all consecutive pregnant patients who were admitted for acute pancreatitis or developed acute pancreatitis during hospitalization were identified. A computerized database was established in 2000 at PMH and patients were registered. The patient

Clinical Characteristics of Acute Pancreatitis in Pregnancy

The annual birth rates were as follows: 16,504 (in 2001), 15,677 (in 2002), 15,549 (in 2003), 16,223 (in 2004), 15,972 (in 2005), and 16,307 (in 2006), totaling 96,232 deliveries during the study period (Figure 1). Ninety-six patients were admitted for acute pancreatitis. The calculated rate of spontaneous acute pancreatitis in pregnancy was thus 1 per 998 births (0.1%). In addition, 7 patients without pre-procedure pancreatitis developed post-ERCP pancreatitis, resulting in a total of 103

Discussion

In this study, although favorable outcomes can be expected in the majority of patients with acute pancreatitis occurring during pregnancy, adverse fetal outcomes (fetal loss and preterm delivery) occurring during the first trimester were prominent. Acute pancreatitis complicated by DIC usually occurs in the third trimester and is particularly associated with poor fetal and maternal outcomes. Acute pancreatitis during pregnancy in the United States was once thought to be rare but appears now to

References (13)

There are more references available in the full text version of this article.

Cited by (71)

  • Acute pancreatitis in pregnancy and its impact on the maternal and foetal outcomes: A systematic review

    2022, Pancreatology
    Citation Excerpt :

    Outcome of APIP varies widely in literature with a probable high maternal death and foetal loss. While maternal and foetal mortality were reported to be higher in the data from 1980s [3], recent observational studies have shown improved maternal and foetal outcomes [2,4]. Generalization of these recent reports with improved outcomes might be inappropriate owing to the heterogeneity of the studies in their reporting and inclusion criteria.

  • Inhibition of macrophage migration inhibitory factor prevents thyroid dysfunction in pregnant rats with acute pancreatitis

    2020, International Immunopharmacology
    Citation Excerpt :

    Similar to non-pregnant patients, causes of acute pancreatitis during pregnancy are diverse and the most common cause of APIP is gallstones [41]. However, APIP generally occurs in the third trimester of pregnancy, during which period patients are more susceptible to critical conditions and intrauterine fetal deaths than non-pregnant patients [2–4]. According to our previous studies, a standardized retrograde injection of 5% STC was able to establish the APIP rat model during the third trimester of pregnancy [32,42].

  • Vaginal Bleeding in Late Pregnancy

    2019, Emergency Medicine Clinics of North America
View all citing articles on Scopus

Conflicts of interest The authors disclose no conflicts.

View full text