Acute pancreatitis during pregnancy.

Introduction. Acute pancreatitis (AP) is an indication for hospital admission, with an increasing incidence, still rare during pregnancy. The most common causes of AP are gallstones (65-100%), especially in pregnancy, alcohol abuse and hypertriglyceridemia. There are limited data available about maternal-fetal outcomes in cases of third-trimester pancreatitis. In cases of acute biliary pancreatitis during pregnancy, the adopted medical approach depends on the gestational age and, also, considering the high risk of recurrence of AP (70%) and the specific risks of each treatment. We present a case report of AP in late third trimester, managed with conservative treatment and elective caesarean section delivery. Methodology and results. A 24-year-old primigravida presented to the emergency room accusing upper abdominal pain, nausea and vomiting. A 38week viable pregnancy was confirmed, with no uterine contractions on cardiotocography. Blood tests revealed amylase/lipase three times above the upper limit of normal. The abdominal ultrasound showed multiple gallstones. Other conditions, such as gastric ulcer and duodenal ulcer, acute appendicitis, acute mesenteric ischemia, HELLP syndrome, placental detachment or uterine rupture, were excluded. In order to care for both mother and the fetus, a multidisciplinary team decided on a conservative management including hydration, administration of antispasmodics, analgesics, antibiotics and correction of electrolyte disturbances. Caesarean section delivery was scheduled, as the fetal calculated growth was over the 90th percentile (4700 g). The immediate postpartum period was uneventful for both mother and neonate. Laparoscopic cholecystectomy was planned six weeks after delivery. Conclusions. The impact of acute pancreatitis can be devastating, causing substantial maternal-fetal morbidity and mortality. This case report underlines the importance of early diagnosis and correct management of AP, especially in pregnancy. A multidisciplinary approach, including gastroenterologists, general surgeons and obstetricians, seems to be the key in making the best choice of management in acute pancreatitis during pregnancy. [ABSTRACT FROM AUTHOR]