Severe Acute Pancreatitis During Pregnancy: Clinical Analysis Of18Cases

Objective: Acute pancreatitis, especially severe acute pancreatitis, duringpregnancy is a rare and dangerous disease. This study aims to present a comprehensiveanalysis of severe acute pancreatitis (SAP) during pregnancy and to analyze the factorsassociated with poor outcomes.Methods: A retrospective review was presented based on the medical records ofpatients with SAP during pregnancy in the1ndaffiliated Hospital of Dalian MedicalUniversity from January2002to December2011.Results: Information about presentation, management, and outcome wasinvestigated. Among eighteen patients diagnosed with SAP during pregnancy,11patients (61.1%) were nulliparous. Most attacks (88.9%) occurred in the third trimester.The ratio of misdiagnosis for obstetric diseases was in4cases(44.44%), in which3cases (33.3%) were misdiagnosed as premature delivery,1case (11.1%) as placentalabruption;5cases were misdiagnosed as digestive system diseases, in which3cases(33.3%) were misdiagnosed as acute cholecystitis and cholelithiasis,1case (11.1%)as acute gastroenteritis,1case (11.1%) as acute appendicitis.There were seven casessuffered preterm labor, six with fetal losses, while no maternal death. The etiologyanalysis showed biliary disease as the main cause in seven patients (38.9%),hypertriglyceridemia in five patients (27.8%), both biliary and hypertriglyceridemia infour patients (22.2%), and idiopathic in two patients (11.1%). Patients with more thanone (≥2) organ failures tended to cause fetal loss (OR=25, P=0.016).Conclusions: Most SAP during pregnancy is caused by biliary in etiology, but asignificant proportion is due to hypertriglyceridemia. Patients with more than one organfailure may cause relatively worse fetal outcomes.