Pancreatitis in Pregnancy
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Pancreatitis is rare in pregnancy with an incidence of 1 in 10,000 approximately. Late diagnosis and delay in treatment result in the worst pregnancy outcomes. It presents mostly in the second or third trimester. Commonest presentation is a biliary disease and rarely hypertriglyceridemia or preeclampsia. There is no significant association between pancreatitis and pregnancy, but there is an association with gallstones. Conservative management and early delivery seem to improve maternal and perinatal outcomes. It is a spectrum of mild to severe disease with necrosis, causing abscesses, pseudocyst, and multi-organ dysfunction.

All pregnant women who were diagnosed as pancreatitis were included in the study. Diagnosis was based on clinical, laboratory and imaging criteria. Diagnosis was by levels of amylase, lipase and ultrasound. Among six patients, average age was 27.5 years (25–30 years), and mean body mass index was 22.8 (15–33). Two of them were chronic with acute presentation and four were acute. Five cases were diagnosed between 18 and 30 weeks, and one was diagnosed on first postnatal day. The commonest clinical symptom at presentation was epigastric pain, vomiting and abdominal distension. Biliary sludge or calculi were the etiology in four cases, and two were secondary to hypertriglyceridemia. Diagnosis was based on amylase and lipase levels. Only one patient who was diagnosed late had pseudo-pancreatic cyst and underwent cesarean delivery due to abruption and had a morbid postnatal period including laparotomy drainage. All the rest had good maternal outcomes. All the offsprings including three preterm deliveries who were followed up to 2 years had a good outcome (Table 4). Recurrence was a common finding.

Most common etiology is gallstones, but non-biliary causes were sought because they are associated with worse outcomes. Preterm deliveries contributed to our increased perinatal morbidity. In this study, there was no maternal and perinatal mortality. Prompt early diagnosis and conservative treatment improved the outcome.

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