The Clinical Study Of Acute Pancreatitis In Pregnancy

Objective: By analyzing clinical features and treatment of acute pancreatits in pregnancy(APIP) in local area,strengthen the clinician awareness of this kind of disease, improving early diagnosis and reduce the rate of misdiagnosis.Methods: 43 cases of acute pancreatitis in pregnancy were collected in Fujian Provincial Hospital from January 2002 to January 2015, and collected same cases of non-pregnant acute pancreatitis with similar age as countpart group, retrospectively analysis the data of the two groups in general, clinical features, laboratory tests, imaging studies and treatment. By comparing the data, summarize the characteristics of APIP.Result:1.General situation: 43 cases of APIP included 9(20.9%) in the first trimester, 11(25.6%) in the second trimester, 20(46.5%) in late pregnancy, 3(7.0%) in the postpartum period, the majority of APIP occurred in the third trimester. Biliary factors(15, 34.9%), hyperlipidemia factors(14, 32.6%) were the main cause of pregnancy group,the rest included 4(9.3%) dietary factors,10(23.3%)other factors. Non-pregnant group included 22(51.2%) biliary factors, 5(11.6%) hyperlipidemia factors, 9(20.9%)dietary factors and 7(16.3%)other causes. Differences in the incidence of different causes among the 2 groups. Pregnancy group was prone to hyperlipidemic AP. 2. Clinical features: ①Pregnancy group included 23 cases(53.5%) MAP, 6 cases(14.0%) MSAP, and 14 cases(32.5%) SAP. Non-pregnant group included 33 cases(76.7%)MAP, 5 cases(11.6%) MSAP, and 5 cases(11.6%) SAP. Two groups of patients were differences in the degree of illness, pregnancy group was prone to SAP. ②Different trimesters of pregnancy and causes presented different severity, the trimester and severity were positively correlated,Pregnancy women in the third trimester of pregnancy or postpartum with a hyperlipidemic cause were prone to SAP.③ Abdominal pain in pregnancy occurred less and milder than the non-pregnantgroup, non-pregnant group was more likely to have significant abdominal pain. Muscle tension, tenderness and bowel sounds diminished or disappeared incidence presented a lower rate than the non-pregnant group. ④ Pregnancy group were prone to pseudocyst, SIRS, sepsis, respiratory failure and gastrointestinal bleeding and other complications. 3.Auxiliary examination: ① pregnancy group was prone to anemia, elevated hematocrit, hypoalbuminemia, hypocalcemia, hyponatremia and elevated serum amylase. ② The principal imaging method to diagnose APIP was B-ultrasound. Though CT examination used less than the non-pregnant group, APIP often associated with a sever CT results. The two groups had no difference in using the B-ultrasound, MRI. 4. Treatment and Prognosis: ① ICU occupancy rate(25.6%) in pregnancy group was higher than non-pregnant group(14%), but the difference was not significant. Pregnancy group use more heparin and insulin than non-pregnant group, the difference was statistically significant. ② The average length of stay of pregnancy women was(16.09 ± 12.17) days, while in non-pregnant patient group, the average length of stay was(14.20 ± 8.98) days.The two groups cured rate, improved rate,mortality and hospitalization days had no significant difference. ③Among 15 cases of pregnant women,4 cases got natural vaginal delivery, 8 cases aheived broken cesarean(53.3% cesarean rate),2 cases had artificial abortion and 1 case had induction. Among 15 cases of fetal, 12 cases were survival, 3 cases of fetal were death(fetal mortality 20%). 4 cases of survival fetal were premature(preterm birth rate 33.3%).Conclusion:1.APIP is more common in the third trimester, biliary disease and hyperlipidemia are the main risk factors of the disease. 2.Compared with non-pregnant,APIP are more prone to SAP, especially APIP occures in the third trimester and postpartum with hyperlipidemia cause often had serious condition. 3. APIP presents atypical clinical manifestations and prone to have more complications.APIP is a disease tremendously threaten maternal-fetal health, whichrequires an early diagnosis through combining laboratory tests and imaging results. 4. Choosing a reasonable way according the different causes and disease condition, and an early and aggressive medical-based individualized and comprehensive treatment strategy is important for prognosis.