The Value Of Serological Indicators In Predicting Fetal Safety In Acute Pancreatitis In The Third Trimester

ObjectiveAcute pancreatitis(AP)is defined as a condition in which pancreatin is abnormally activated and digesting its own tissues,leading to local inflammatory responses in the pancreas,with or without dysfunction of other organs.Acute pancreatitis in pregency(APIP)is a rare critical complication of pregnancy and puerperium,with an incidence of 1/1000-1/12000.The disease progresses rapidly and is in serious condition.The abortion rate,premature birth rate and fetal mortality rate of patients are significantly higher than those of general pregnant women.Considering the fetal factors,the diagnosis and treatment of APIP cannot completely follow the diagnosis and treatment guidelines of ordinary pancreatitis.Due to the limited treatment options and drug application,the disease progression of APIP is often unable to be effectively controlled,resulting in maternal and perinatal mortality rates as high as 20%and 37.9%.In recent years,with the improvement of the early diagnosis,monitoring and treatment of this disease,the maternal and fetal mortality rates have been significantly reduced.The APIP is more common in the third trimester.In the third trimester with acute pancreatitis,not only maternal factors should be considered,but also the impact of changes in the condition on the fetus and the time to terminate the pregnancy in order to reducing fetal mortality.When evaluating fetal conditions,electronic fetal heart monitoring,counting fetal movement and fetal vascular ultrasound Doppler blood flow spectrum detection are the clinical basis.However,when combined with acute pancreatitis,due to the critical condition,it is often unable to do imaging examination in time and rely on fetal heart monitoring and fetal movement to judge the safety of the fetus.Fetal heart rate measurement and electronic monitoring are instantaneous and can only reflect the situation in a short time.Fetal movement count is affected by fetal sleeping and use of analgesic and sedative drugs,and when pancreatic inflammation affects the abdominal cavity,inflammatory stimulation causes contractions,which will also affect fetal movement judgment.Some studies have found that maternal biochemical indexes are related to the severity of APIP,and the severity of disease will affect the prognosis of mother and child.If maternal serological changes have a certain predictive effect on fetal safety,it can assist evaluation of fetal conditions,which provides a new idea for the treatment of APIP and the choice of the timing of pregnancy termination.The purpose of this study was to analyze the correlation between serological indexes before delivery and Apgar score at 1 min in patients with acute pancreatitis in the third trimester,to explore the predictive value of serological indexes for fetal safety,and to provide some reference for the timing of termination of pregnancy in patients with acute pancreatitis in the third trimester.Methods1.Collecting casesA total of 64 patients with APITT who were admitted to the First Affiliated Hospital of Zhengzhou University from June 2012 to December 2020 and terminated their pregnancies in our hospital were collected.The diagnostic criteria for acute pancreatitis were based on the Atlanta Classification Diagnostic Criteria for Acute Pancreatitis and the Guidelines for the Diagnosis and Treatment of Acute Pancreatitis in China(Shenyang,2019).Among the enrolled patients,26 cases were included in the observation group and 38 cases in the control group based on whether the newborn delivery was asphyxia or not.All the clinical data required were complete.2.Observational indexTh severity of disease,gestational age of termination and birth weight of newborn were compared between the two groups.Whether the maternal serological indicators(blood glucose,serum calcium,CRP,PCT,NLR,amylase,lipase,triglyceride and liver enzymes)before termination of pregnancy are statistically different,and whether they are related to Apgar score at 1 min after birth.The best cutoff corresponding to the relevant indexes and their sensitivity and specificity.Patients were regrouped according to the best cutoff value of meaningful indicators,and the severity of maternal disease,incidence of fetal distress,and fetal outcome(gestational age,birth weight,1 min,5 min,10 min Apgar score)were compared between the two groups for statistical significance.3.Statistical methodsThe IBM SPSS Statistics 22.0 software was used for analysis.Chi-square test was used to compare qualitative data between groups.Quantitative data comparison between the two test,obey the normal distribution of measurement data using independent sample t-test,represengting as(x±s),do not obey the normal distribution of measurement data and the parameter variables the Mann-Whitney U test,represengting as((M)(P25～P75)),P<0.05 was considered statistically significant.Spearman correlation method was used to test the correlation between observation indexes and Apgar score at 1 min after birth.According to ROC curve and Youden index,the threshold value of the highest diagnostic accuracy of each index was calculated,as well as the sensitivity and specificity corresponding to this value.The area under the ROC curve(AUC)>0.7 was of high diagnostic value.The larger the area,the higher the accuracy.Result1.A total of 64 patients were included in the study group,including 26 patients in the observation group and 38 patients in the control group.There was no significant difference in gestational age of pregnancy termination and birth weight of newborn(P>0.05).Namely,in this study,the Apgar score at 1 min after birth of newborns was not affected by gestational age and birth weight,and the two groups of mothers were comparable.2.The observation group had 18 cases of severe acute pancreatitis,8 cases of mild or moderate severe pancreatitis.In the control group,there were 7 cases of severe acute pancreatitis and 31 cases of mild and moderate severe pancreatitis.Chi-square test showed that the incidence of severe acute pancreatitis in the observation group was significantly higher than that in the control group.3.The levels of blood glucose,CRP,PCT and serum amylase in the observation group were higher than those in the control group,while the levels of serum calcium were significantly lower than those in the control group,the diference was statistically significant(P<0.05);The difference of serum triglyceride,serum lipase and liver enzyme in the two groups was not statistically significant.4.Spearman correlation analysis showed that:Apgar score at 1 min after birth was significantly correlated with maternal blood glucose,serum calcium,CRP and PCT levels before delivery,p<0.01,meaning Apgar score at 1 min after birth was negatively correlated with maternal blood glucose,CRP and PCT levels,and positively correlated with serum calcium levels.The correlation analysis between neonatal Apgar score at 1 min after birth and maternal blood amylase level before delivery was no significant correlation.5.ROC curve analysis results showed that the AUC of blood sugar,blood calcium and PCT were greater than 0.7,meaning good predictive value.The optimal critical values were 8.83mmol/L,1.745mmol/L,0.295ng/mL,respectively,according to the maximum approximate deng index.The sensitivity and specificity were about 70%.The combined index of the three is of the best value in predicting fetal safety,which sensitivity and specificity were 69.2%and 86.8%respectively for predicting fetal safety.While CRP corresponding to AUC is less than 0.7,the predictive value is weak and insignificant.6.When the patients were regrouped according to the optimal cut-off values of blood glucose,serum calcium and PCT,there were no statistically significant differences in gestational age and birth weight among the groups(P<0.05).The incidence of severe pancreatitis and fetal distress in the high blood glucose group was higher than that in the low blood glucose group,while the Apgar scores of neonates at 1 min,5 min and 10 min were all lower than those in the low blood glucose group,the differences were statistically significant.The results of low serum calcium level group/high serum calcium level group and high PCT level group/low PCT level group were consistent with those of high blood glucose level group/high blood glucose level group.Conclusion1.The severity of the disease in patients with acute pancreatitis in the third trimester affects the prognosis of the fetus.The more severe the disease,the greater the possibility of fetal distress and neonatal asphyxia.2.Apgar score at 1 min after birth is significantly correlated with maternal blood glucose,serum calcium and PCT levels before pregnancy termination.The higher the blood glucose and PCT levels,the lower the serum calcium levels,the greater the risk of fetal distress and neonatal asphyxia.The combined diagnostic value of blood glucose,serum calcium and PCT was higher than that of a single index.3.The detection of biochemical indicators is relatively economical and simple,the results are easy to obtain in early stage,and the repeatability is strong,which provides a new idea for predicting fetal safety of pancreatitis in the third trimester and selecting the timing of pregnancy termination,and is worthy of clinical application.