Analysis Of Clinical Characteristics With Acute Pancreatitis In Pregnancy

Objective:To analyze the clinical characteristics of 49 patients with acute pancreatitis in pregnancy(APIP),who were admitted to the obstetrics department of the first affiliated Hospital of Kunming Medical University,to discuss the pathogenic factors,clinical characteristics,auxiliary examination results,the choice of termination method,pregnancy outcome,treatment plan,and the mother and child prognosis of patients with acute pancreatitis in pregnancy,so as to provide reference for clinical work.Methods:Clinical data of 49 patients with acute pancreatitis in pregnancy in the first affiliated Hospital of Kunming Medical University from January 1,2014 to January 1,2020 were collected,and the clinical date of these patients were all retrospectively analyzed,In this study the date was divided into three groups according to the severity of the disease:mild APIP group has 28 cases,moderately severe APIP group has 11 cases and severe APIP group has 10 cases.The clinical data of MAP group,MSAP group and SAP group were all analyzed and compared:(1)General information:age,body mass index(BMI),onset of gestational weeks,length of hospital stay,maternity,routine prenatal examinations and planned pregnancy;(2)Etiology:biliary diseases,hyperlipidemia and other factors(hypertension during pregnancy,diabetes,idiopathic factors,etc.);(3)The most serious laboratory test results within 24 hours after admission,including white blood cells,serum amylase,serum lipase,blood calcium,total cholesterol,triglyceride,random blood glucose and C-reactive protein;(4)Imaging examination:abdominal B-ultrasound,abdominal CT,abdominal MRI usage and positive detection rate;(5)pregnancy outcome:full-term delivery,premature delivery,abortion,stillbirth induction and continuation of pregnancy;(6)Termination of pregnancy:vaginal delivery and cesarean section;(7)Maternal and infant outcome:maternal death,transfer to ICU,fetal loss,fetal distress,neonatal asphyxia,low birth weight infants,and neonatal transfer to pediatrics.The above indexes were analyzed to explore the characteristics of acute pancreatitis in pregnancy and to compare the effects of different severity of APIP on pregnancy outcome,delivery mode and maternal and infant prognosis.Results:(1)Comparison of general conditions:there was no statistical difference among the three groups(MAP,MSAP and SAP groups)in the proportion of maternity,the average age and average gestational week(P>0.05);There was no statistically significant difference in the incidence of early pregnancy,second trimester and third trimester among the three groups(P>0.05);There were obvious differences in the incidence of routine prenatal examinations and planned pregnancy among the three groups,the incidence in MAP group was obviously higher than that in MSAP group or SAP group,and that in MSAP group was higher than that in SAP group(P<0.05);The average length of hospital stay in SAP group was significantly longer than that in MSAP group and MAP group(P<0.05);There was no statistical difference in the proportion of normal weight,overweight and first-degree obesity among the three groups(P>0.05),but there was statistical difference in the incidence of Ⅱ-degree obesity among the three groups,the incidence of Ⅱ-degree obesity in SAP group was significantly higher than that in MSAP group and MAP group(P<0.05).(2)Etiology:The most common causes were biliary diseases(46.9%),hyperlipidemia(32.7%)and other causes(20.4%);There was statistical difference in different etiology among the three groups(MAP group,MSAP group and SAP group)(P<0.05),Pairwise comparison of different causes among the three groups:the proportion of APIP with different severity in biliary APIP group and hyperlipidemia APIP group was statistically significant different(P=0.001,P<0.05),and MAP was the most common in biliary APIP(82.6%),among the hyperlipidemia APIP,MSAP and SAP were the most common(a total of 75.0%);There was no significant difference in biliary APIP between hyperlipidemia APIP and APIP caused by other causes(P>0.05).(3)The results of laboratory examination:There was no statistical difference in average serum amylase and lipase among the three groups(P>0.05);But there were significant differences in average white blood cell,total cholesterol,triglyceride,random blood glucose and C-reactive protein among the three groups,which in SAP group was significantly higher than that in MSAP group or MAP group,and that in MSAP group was significantly higher than that in MAP group(P<0.05);The average degree of serum calcium decreased among the three groups,and the average value of serum calcium in SAP group was significantly lower than that in MSAP group or MAP group(P<0.05).(4)Imaging examination:in terms of the utilization rate of abdominal B-ultrasound,CT and MRI,B-ultrasound(100.0%)>MRI(73.5%)>CT(53.1%),the difference was statistically significant(P<0.05);In the positive detection rate,CT(100.0%>MRI(97.2%)>B-ultrasound(61.2%),the difference was statistically significant(P<0.05).(5)Mode of delivery:there were 49 cases of APIP,of which 9 cases continued pregnancy and 40 cases terminated pregnancy;The cesarean section rate among the three groups was SAP group(6 cases,75.0%)>MSAP group(5 cases,55.6)>MAP group(5 cases,21.7%),The difference was statistically significant(P<0.05).(6)Pregnancy outcome,maternal and infant prognosis:The incidence of ICU,total hospital stay>10 days,fetal distress,neonatal asphyxia,low birth weight infants and neonatal transfer to pediatrics in SAP group>MSAP group>MAP group,the difference was statistically significant(P<0.05);The difference was statistically significant in the incidence of full term delivery among the three groups:MAP group>MSAP group>SAP group(P<0.05);There was no significant difference in the incidence of preterm delivery,fetal loss and continued pregnancy among the three groups:SAP group>MSAP group>MAP group(P>0.05).Conclusion:(1)The main causes of acute pancreatitis during pregnancy were biliary diseases and hyperlipidemia,in which biliary diseases were the primary pathogenic factors leading to APIP;In recent years,with the improvement of living standards,the incidence of hyperlipidemic APIP has increased;MAP is the most common APIP caused by biliary diseases,and APIP caused by hyperlipidemia is most common in MSAP and SAP.(2)APIP could occur in any period of pregnancy,but most in the third trimester;With the increase of obesity index,the condition of APIP was more serious,obesity was one of the risk factors of APIP.(3)The results of laboratory examination of white blood cells,total cholesterol,triglyceride,random blood glucose,C-reactive protein and serum calcium may be of predictive value to the severity of APIP patients;abdominal ultrasound was the first choice for imaging examination of APIP patients,The utilization rate of MRI is second only to abdominal ultrasound,and the utilization rate of abdominal CT is the lowest,but its positive rate is significantly higher than that of abdominal MRI and abdominal ultrasound.(4)With the increase of the severity of APIP patients,the higher the rate of cesarean section,cesarean section may be the first choice for SAP patients.(5)With the increase of severity,the higher the rate of maternal conversion to ICU,the longer the hospitalization time;and the higher the incidence of fetal distress,neonatal asphyxia,low birth weight and neonatal pediatrics.(6)Conservative treatment was the main treatment of APIP,combined with surgical treatment when necessary;mild to moderately severe APIP was mostly improved after conservative treatment,severe APIP should strictly grasp the indication and timing of surgical and obstetrical intervention to improve the adverse outcome of mother and infant.