Analysis Of 60 Cases Of Pregnancy Complicated With Acute Pancreatitis

Objective: To investigate the influence of age,pregnancies,gestation,pancreatitis etiology,body mass index on the severity of acute pancreatitis during pregnancy,and the influence of acute pancreatitis during pregnancy on laboratory examination and pregnancy prognosis.Methods: The study analyzed the clinical data of 60 patients with acute pancreatitis during pregnancy from January 2006 to December 2015 in Sichuan Provincial People's Hospital.According to the criteria for the diagnosis of acute pancreatitis(2014),the severity of the classification,patients were divided into mild,moderate and severe three groups.Analysis of the age,pregnancies,gestation,possible cause(biliary,hyperlipidemia,other),BMI,laboratory test indicators(HS-CRP,GLU,CA,ALB,AST,ALT,TB,DB,UAMY,AMY,LIPA,TG,ALP)and pregnancy prognosis.Results:1.General situation comparison: patients aged from 17 to 40 years old,of which 19 cases of primipara(31.67%),the maternal 41 cases(68.33%);pregnancy classification: early gestation 5 cases(8.33%),3 cases(5.00%)in the middle gestation,52 cases(86.67%)in late gestation;Disease severity classification: MAP 34 cases(56.67%),14 cases of MSAP(23.33%),SAP 12 cases(20.00%);Etiology classification: 35.00%(21/60)of Biliary,Gallstones 23.33%(14/60),cholecystitis 8.33%(5/60),common bile duct stones 1.67%(1/60),cholangitis 1.67%(1/60),33.33%(20/60)of hyperlipidemia,and 31.67%(19/60)of other patients included 10 cases(16.67%)of dietary factors,Hyperparathyroidism in 3 cases(5.00%)of unknown in 6 cases(10.00%).2.The severity of APIP:(1)age,pregnancies,pregnancy on the severity of the disease: different age,number of pregnancies,pregnancy severity of the disease were not significant different(P>0.05).(2)The effect of the etiology on the severity of APIP: There were significant differences in the severity of the disease caused by different etiology(P<0.05).And then we compared the two groups,the test level correction for the ? = 0.017,and there is a significant difference between the two groups(P<0.017);But the biliary cause group,hyperlipidemia etiology group were compared with other causes,There was no significant difference in the incidence of disease at different severity(P>0.017)(3)Effect of BMI on severity of APIP: There were no significant differences in the three groups of normal,overweight,and the type I obesity group(P>0.05);In the type II obesity group,there were significant differences between the three groups(P<0.05);According to the correlation analysis of BMI,the severity of the disease increased with the increase of BMI grade,showing a positive correlation(r=0.269)(4)Comparison of laboratory indexes with APIP:(1)general serum indicators: compared the three groups of different severity of APIP in AMY,UAMY,LIPA no significant difference was observed(P>0.05);There were significant differences between the three groups of patients with HS-CRP,CA,GLU,TG(P<0.05),Compared with the two groups,there were differences between the two groups(P<0.05);The specifically embodied,with the severity of pregnancy with acute pancreatitis increased,HS-CRP,GLU,TG are increasing,CA continue to decrease.(2)The liver function index: There were significant differences in ALT,AST and ALB in APIP with different severity(P<0.05),With the severity of the disease increased,ALT and AST levels continue to increase,ALB levels continue to decrease;although the data show that with the disease exacerbations,TBIL and DBIL levels also showed increasing trend,but the comparative analysis of between groups shows that the TBIL and DBIL levels only in MAP and SAP the differences(P<0.05).3.Effect of APIP on pregnancy prognosis: In this study,no maternal deaths,perinatal children died in 6 cases.There were 25 cases(41.67%)in the termination of pregnancy:2 cases of adolescent pregnancy(3.33%);1 case of middle-term pregnancy induced by labor(1.67%);22 cases of cesarean section termination of pregnancy(36.67%),11 cases of fetus to reach full-term cesarean section,another 11 cases due to treatment during the fetus intrauterine distress signs emergency cesarean section.There were no significant differences in caesarean section and preterm birth rate between three different severity groups(P> 0.05);MAP group in the full-term pregnancy rate was higher than that of MSAP and SAP,the difference was statistically significant(P<0.05);In the Three different severity groups,there were significant differences in the rate of maternal pregnancy,the incidence of fetal distress,the incidence of neonatal asphyxia and mortality(P<0.05).The risk of Fetal distress,stillbirth,neonatal asphyxia and even death were significantly higher in pregnant women with SAP.Surgical intervention in 11 cases,of which 6 cases of acute pancreatitis is not serious,intraoperative not disturb the pancreas only peritoneal drainage;5 cases of SAP patients with pancreatic necrotic tissue clearance a nd pancreatic drainage,of which there are 2 cases with gallstones Plus cholecystectomy and biliary exploration.Conclusion: 1.biliary and hyperlipidemia are the main causes of APIP,the main cause of biliary disease was MAP,and hyperlipidemia are more likely to result in MSAP to SAP.2.With the increase in BMI,the severity of the combined APIP increased the trend.3.With the severity of the APIP graded,the degree of liver damage increased the trend.4.The risk of Fetal distress,stillbirth,neonatal asphyxia and even death were significantly higher in pregnant women with SAP.5.In the pregnancy complicated with MAP and MSAP patients,the use of active non-surgical treatment,and more can be effectively controlled,the prognosis is better;in pregnancy complicated with SAP patients,in addition to active non-surgical treatment,If there are obstetric and surgical intervention guidelines need to consider surgery,treatment options as much as possible cesarean section,combined with the choice of surgical surgical conditions.