Acute pancreatitis in pregnancy

OBJECTIVE: Our purpose was to determine the cause and describe the natural history of acute pancreatitis complicating pregnancy and its effect on maternal and perinatal outcomes. STUDY DESIGN: Over the last decade we admitted 43 pregnant women with acute pancreatitis to our hospital. We reviewed presentation, diagnosis, management, and maternal and perinatal outcomes. RESULTS: The incidence of acute pancreatitis was one in 3333 pregnancies. The mean age of these 43 women was 24 years, 31 (72%) were multiparous, and pancreatitis was associated with biliary disease in 29 (68%). All had a favorable response to supportive therapy that included bowel rest, intravenous hydration, and antimicrobial therapy. Cholecystectomy was performed for persistent or recurrent biliary or pancreatic disease ante partum in eight women and post partum in another 12. Of 39 women who were delivered at our hospital, 32 were at term and their infants did well. The other six infants were delivered preterm; two were stillborn and another died after birth. One woman underwent a therapeutic abortion. CONCLUSIONS: Most pregnant women with acute pancreatitis have associated biliary tract disease. With prompt hospitalization, supportive care, and surgical intervention when indicated, maternal and fetal morbidity and mortality are not prohibitive. Fetal death and preterm delivery may result from severe disease.