From the Guidelines
Acute pancreatitis in pregnancy is a serious condition that requires prompt medical attention and a multidisciplinary approach involving obstetricians, gastroenterologists, and other specialists, including an advanced endoscopist experienced in ERCP, MFM physician, neonatologist, and anesthesiologist 1.
Initial Management
The primary recommendation is to hospitalize the patient for close monitoring and supportive care, which includes:
- IV hydration
- symptom control
- antibiotics
- nutritional support 1.
Specific Treatment
In terms of specific treatment, the focus is on supportive care, and the use of medications to manage symptoms and prevent complications.
- ERCP can be performed during pregnancy to manage choledocholithiasis, cholangitis, and acute biliary pancreatitis with a retained bile duct stone, but it is essential to minimize fetal radiation exposure and monitor the fetus before and after the procedure 1.
- Technical outcomes of ERCP in pregnant women are uniformly favorable, but patients undergoing ERCP in the first trimester had relatively poor fetal outcomes, including a low rate of term pregnancies, high rate of low-weight newborns, and high risk of preterm delivery 1.
Fetal Radiation Exposure
To minimize fetal radiation exposure, various measures should be taken, including:
- Using the lowest possible radiation dose
- Placing the patient in the supine or prone position in the first trimester, and in the left pelvic tilt or left lateral position in the second and third trimesters
- Administering thromboprophylaxis and antibiotic prophylaxis when indicated 1.
Multidisciplinary Approach
In all cases, a multidisciplinary approach is crucial to ensure the best possible outcomes for both the mother and the fetus, and patients should be transferred to a tertiary care setting for treatment management by an experienced endoscopist and for multidisciplinary care, especially if possible 1.
Key Considerations
Pregnancy is an independent risk factor for post-ERCP pancreatitis, and the risk of post-ERCP pancreatitis is higher in nonteaching vs teaching hospitals, therefore, patients should be managed in a tertiary care setting whenever possible 1. It is essential to monitor fetal well-being and maternal condition closely, with regular assessments of vital signs, laboratory tests, and imaging studies as needed, and the decision to deliver the baby depends on the gestational age and the severity of the condition.
From the Research
Implications of Acute Pancreatitis in Pregnancy
The implications of acute pancreatitis in pregnancy are significant, with potential risks to both the mother and the fetus. Some of the key implications include:
- Maternal morbidity and mortality: Acute pancreatitis can lead to severe complications, such as organ failure, infection, and death 2, 3.
- Fetal morbidity and mortality: The condition can increase the risk of preterm delivery, stillbirth, and fetal death 3.
- Diagnostic challenges: Acute pancreatitis can be difficult to diagnose during pregnancy, due to non-specific symptoms and physical changes that occur during pregnancy 2, 4.
- Treatment challenges: Management of acute pancreatitis during pregnancy requires careful consideration of the mother's and fetus's health, and may involve a multidisciplinary approach 4, 5.
Etiology and Risk Factors
The etiology of acute pancreatitis in pregnancy is often related to:
- Gallstones: The most common cause of acute pancreatitis in pregnancy, accounting for up to 56% of cases 4.
- Hypertriglyceridemia: A rare but potentially life-threatening cause of acute pancreatitis in pregnancy 6.
- Alcohol consumption: A less common cause of acute pancreatitis in pregnancy, but still a significant risk factor 4.
Management and Outcomes
The management of acute pancreatitis in pregnancy typically involves:
- Supportive care: Fluid resuscitation, electrolyte repletion, and pain management 5.
- Endoscopic retrograde cholangiopancreatography (ERCP): May be performed to remove gallstones or relieve bile duct obstruction 2, 4.
- Surgical intervention: May be necessary in some cases, such as cholecystectomy or cesarean delivery 2, 3.
- Multidisciplinary care: Involving obstetricians, gastroenterologists, and other specialists to ensure optimal outcomes for both the mother and the fetus 4, 6.