A Clinical Analysis Of Acute Pancreatitis In Pregnancy In 73 Cases

ObjectiveAcute pancreatitis?AP?is one of common acute abdominal pain,but acute pancreatitis in pregnancy?APIP?is a rare disease,and the incidence of acute pancreatitis in pregnancy has been cited between one in 1000 to one in 12000.The most common causes of acute pancreatitis in pregnancy are hyperlipidemia,gallstones,alcohol abuse,idiopathic,and less commonly hyperparathyroidism,,trauma,drugs,and fatty liver of pergnancy.Acute pancreatitis in pregnancy significantly threatenes the maternal and fetal health.Acute pancreatitis in pregnancy has rapid onset,rapid progress,high mortality,and it is easy to be misdiagnosed.Timely diagnosis and treatment can reduce the maternal and fetal mortality.In recent years,the maternal and fetal mortality has been reduced due to early diagnosis and timely treatment.If diagnosis and treatment are delayed,maternal complications will increase,such as pneumonia,pleural effusion,abdominal effusion,electrolyte disorder,peritonitis,sepsis,systemic inflammatory response syndrome?SIRS?,multiple organ dysfunction syndrome?MODS?,pancreatic pseudocyst.For the fetus,the possibility of fetal complications increase,including premature delivery,abortion,fetal intrauterine distress,fetal death.MethodsIn this study,we retrospectively reviewd 73 cases of acute pancreatitis in pregnancy hospitalized in the First Affiliated Hospital of Zhengzhou University from2012 to 2017 to describe the types,clinical characteristics,maternal and fetal outcomes of acute pancreatitis in pregnancy.Results1.The main causes for acute pancreatitis in pregnancy were idiopathic pancreatitis?46.6%?,hyperlipidemia?24.7%?,biliary pancreatitis?15%?.Other causes of APIP inciude hypertension?5 cases?,diabetes?4 cases?,abnormal liver function?1 case?.2.Among acute pancreatitis in pregnancy in 73 cases,71 patients?97.3%?were in single pregnancy and 2 patients?2.7%?were in twin pregnancy.The average age range of patients is 18 to 44.All patients were at gestational week 14⁺⁶-39⁺⁵ at the time of APIP diagnosis.There were 33 patients?45.2%?on primipara and 40patients?54.8%?on multipara.We noted that 13 patients?17.8%?in had APIP during the second pregnancy,52 patients?71.2%?in third pregnancy and 8 patients?11%?.in puerperal period.64.4%?47?were mild acute pancreatitis?MAP?,28.8%?21?moderate acute pancreatitis?MSAP?and 6.8%?5?were severe acute pancreatitis?SAP?.3.In this study,we found that abdominal pain,nausea and vomit the three most predominant clinical symptoms in our patients.The location of abdominal pain was mainly in the upper abdomen,which occurred in 80.8%patients?59/73?.More than half of the patients had nausea?56.2%,41/73?,vomit?54.8%,40/73?.Other clinical symptoms include tenderness?13.7%,10/73?,rebound pain?4.1%,3/73?,diarrhea?1.4%,1/73?.Systemic complications include sepsis?2 cases?,MODS?3 cases?,SIRS?1 case?,and MOF?1 case?.4.In this study,some commonly used laboratory results were compared among the second pregnancy,the third pregnancy and puerperal period.Only the level of serum amylase,serum lipase,white blood cell count,hemoglobin,the ratio of neutrophil,the ratio of lymphocyte and neutrophil/lymphocyte ratio,alkaline phosphatase,albumin,total cholesterol,HDL,and PH were correlated with the gestational week of APIP?P<0.05?.5.In this study,some commonly used laboratory results were compared among MAP,MSAP and SAP based on the severity.Only the level of hospitalization days,serum lipase,hemoglobin,CRP,random blood sugar,AST,total protein,albumin,total cholesterol,triglycerides,D-dimer,fibrinogen and blood calcium were correlated with the severity of APIP?P<0.05?.6.In this study,26.3%?5?were mild acute pancreatitis?MAP?in HTGP,52.6%?10?moderate acute pancreatitis?MSAP?in HTGP and 21.1%?4?were severe acute pancreatitis?SAP?in HTGP.The difference between the two groups was statistically significant,and the level of triglycerides was correlated with the severity of APIP?P<0.001?,suggesting that APIP induced by hypertriglyceridemia tends to be correlated with severe clinical symptoms.7.In this study,the level of serum glucose and serum calcium were correlated with the severity of APIP?P<0.05?.However,white cell count was not correlated with the severity of APIP.8.In this study,there was no statistically significant difference in adverse outcomes between acute biliary pancreatitis and acute hypertriglyceridemia pancreatitis?P>0.05?.9.In this study,there was no case of maternal death in total.However,there were 7 cases of fetal death in total.The fetal mortality was 10.8%,including fetal death?4 cases?before admission and abortion?3 cases?requested by patients and their families.All the 39 neonates survived from termination,including full-term infants?5 cases?and premature infants?34 cases?.Among the 34 premature infants,10 infants?29.4%?were neonatal asphyxia,and 15 infants?44.1%?were neonatal respiratory distress syndrome,and 18 infants?52.9%?were neonatal hyperbilirubinemia,and 22 infants?64.7%?were neonatal intracranial hemorrhage,and 16 infants?47.1%?were neonatal infection.10.In this study,some commonly used laboratory results were compared among MAP,MSAP and SAP based on the severity.Only neonatal asphyxia and neonatal respiratory distress syndrome were correlated with the severity of APIP of the mother?P<0.05?.11.In our study,65 patients were in pregnancy.46 patients were under termination of pregnancy.Among the 46 patients,40 patients chose cesarean section,and 1 patient produced a full-term infant,and 5 patients did the abortion.24 patients were mild acute pancreatitis?MAP?,17 patients moderate acute pancreatitis?MSAP?and 5 patients were severe acute pancreatitis?SAP?.Among the 73 patients,3patients had operation for cholecystectomy,and 2 patients had operation for gallbladder fistula,5 patients had operation for pancreatic necrotic tissue removal and drainage,and 15 patients had operation for simple pelvic and peritoneal drainage.Conclusion1.The main causes of acute pancreatitis in pregnancy are idiopathic pancreatitis,hyperlipidemia and biliary pancreatitis.2.Acute pancreatitis in pregnancy most commonly occurred in the third pregnancy.73 cases in APIP were usually mild acute pancreatitis.3.hyperlipidemia,hyperglycemia and hypocalcemia in APIP is more likely to correlate with severe pancreatitis.5.There was no significant difference in adverse outcomes between acute biliary pancreatitis and acute hyperlipidemia pancreatitis.6.Premature infants of the mother in severe acute pancreatitis are more likely to suffer from neonatal asphyxia and neonatal respiratory distress syndrome.