Etiology and prognosis in patients with acute pancreatitis during pregnancy

Introduction and Aim: Our study included patients diagnosed with acute pancreatitis (AP) during pregnancy at the Gastroenterology Department of Harran University Medical Faculty Hospital between 2019 and 2022. The etiology, prognosis, and effects on the fetus in patients diagnosed with AP during pregnancy were examined in this study. Material and Method: The data of the patients were collected prospectively. AP diagnosis was based on three criteria: abdominal pain, serum amylase and lipase levels three times higher than normal, and characteristic pancreatitis findings on ultrasound or magnetic resonance imaging. Patients with two positive criteria were diagnosed with acute pancreatitis. AP was classified as mild, moderate, or severe according to the modified Atlanta criteria. Results: A total of 20 patients, with a median age of 28 (19-45 years), were included in the study. The median BMI of the patients was 28.5 kg/m2 (20-39.1). The median gestational week at which they experienced AP was 28 (one patient in the first trimester, seven patients in the second trimester, twelve patients in the third trimester, the lowest being the 8th week, and the highest being the 39th week). Five (25%) patients had a history of AP before becoming pregnant. Eight patients experienced an AP attack during their first pregnancy. Among the patients, 15 (75%) had biliary pancreatitis, 3 (15%) had pancreatitis due to hypertriglyceridemia, 1 (5%) had pancreatitis due to scorpion sting, and 1 (5%) had post-ERCP pancreatitis. Nine (50%) patients had normal deliveries, and nine (50%) underwent cesarean section. At the time of writing this article, two patients were still pregnant. Cholecystectomy was performed on nine patients after delivery. Of the fetuses, 14 (70%) were male, and 6 (30%) were female. The median birth weight was 2975 grams (2250-3800 grams), and the median APGAR score was 9. Sixteen fetuses had no anomalies at birth, while one newborn was monitored in the intensive care unit due to omphalitis. Eighteen patients (90%) had mild AP, and one patient (5%) had moderate to severe AP. One patient (5%) who experienced severe AP due to hypertriglyceridemia died after abortion in the 35th week of pregnancy. XI Conclusion: In our study, the most common cause of AP during pregnancy was biliary pancreatitis, followed by pancreatitis associated with hypertriglyceridemia. Acute pancreatitis attacks during pregnancy can lead to serious morbidity and, as in one of our patients, mortality in both the mother and the fetus. Keywords: Pancreatitis in pregnancy, acute pancreatitis