| Acute pancreatitis in pregnancy(APIP)is a life-threatening complication for both mother and fetus.Due to its atypical presentations and rapid clinical changes,APIP is easily misdiagnosed and missed by clinicians,resulting in serious adverse maternal and neonatal outcomes.Over the past decades,the APIP-associated mortality rate was high for the mother and fetus.And as a consequence of advances in medical knowledge and technology,recent studies have reported an obvious decline in serious complication rate.Clinicians have noticed that APIP has a different clinical profile from acute pancreatitis in the general population because of the particularity of pregnancy status.Until now,there is a lack of epidemiological data on APIP in China.Besides,most APIP studies involved small,single-center investigations with a long reference timeperiod;as such,conclusions may not be generalizable to all patients and all living environments.Through a multi-angle analysis of APIP,this study set out to provide new references for perinatal health care and timely treatment.Part 1 The epidemiological meta-analysis of APIP.Objective:To analyse and summarize the epidemiological features and its trend of APIP over the past 20 years in China.Methods:A literature search of published papers in Chinese or English about clinical features of APIP in Wanfang database,China National Knowledge Infrastructure database,PubMed and Web of Science was performed.Stata 16.0 software was used for the meta-analysis.Results:A total of 49 articles were included.The incidence rate of biliary APIP was 35%and hyperlipidemic APIP was 34%.The incidence rate of severe cases was 28%.The APIP-associated maternal and fetal mortality rates were 0.19%and 11%,respectively.In the comparison between the two decades,the incidence of hyperlipidemic APIP increased from 31%to 37%and the rate of severe APIP reduced from 31%to 25%,while other comparisons were not statistically significant.Conclusion:Now,hyperlipidemia has become the leading cause of APIP in China.Although the incidence rate of severe APIP has declined,it is still relatively high.APIP was the leading cause of fetal loss due to non-obstetric factors.We still need to raise the awareness of APIP and be alert to the occurrence of APIP.Part 2 The multicenter clinical research of APIP.Objective:To explore the etiology,clinical indices and maternofetal outcomes of APIP and the early predictive markers of severe APIP.Methods:A retrospective analysis of 77 diagnosed APIP patients admitted to the Nanfang Hospital Affiliated to Southern Medical University and The First Affiliated Hospital of Jinan University from January 2010 to June 2022 and The Third Affiliated Hospital of Guangzhou Medical University,Dongguan People Hospital,and Shenzhen People Hospital from January 2015 to June 2022 was performed.According to the severity of APIP,this study compared the etiology,clinical characteristics,laboratory indices and maternofetal outcomes among three types of APIP.The study also tracked the long-term outcomes of newborns in mild APIP and explored the predictive markers of severe APIP.Results:The most common causes of APIP were hypertriglyceridemia(39.0%).The initial heart rate recorded after admission was correlated with the severity of APIP and its ability to predict severe APIP was highest.The hospital stay duration and hospital costs were significantly associated with disease severity.54.5%neonatal asphyxia was observed in severe APIP.Apgar scores among newborns of mild APIP were not different.Conclusion:Hyperlipidaemia took the first place among APIP etiologies now.The heart rate might be the new predictors of severe APIP.The severity of APIP was associated with higher risk of neonatal asphyxia.For mild APIP patients,conservative treatment was also desirable.We need to improve the health management among pregnant women.Once acute abdomen occurs in pregnant woman,we need to be alert to the occurrence of APIP.Timely diagnosis and aggressive treatment can reduce a burden on the healthcare system. |
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