A Case Series of Pancreatitis in Pregnancy: Etiology, Diagnosis, Treatment, and Outcomes

Abstract

Introduction: Reports in the literature suggest that pancreatitis in pregnancy most often occurs in the third trimester as a result of gallstone disease. Advances in diagnosis and management have resulted in improved prognosis in recent years. We performed this study at our tertiary care facility to examine the risk factors, etiology, and treatment of pancreatitis in pregnancy and factors associated with adverse outcomes. Methods: Retrospective chart review of pregnant patients diagnosed with pancreatitis during the 21 year period between 01/01/1994 and 12/01/2014 with capture of information regarding demographics, clinical presentation, trimester of pregnancy at diagnosis, endoscopic retrograde cholangiopancreatography (ERCP) findings, maternal and fetal outcomes, and treatment efficacy. Results: A total of 25 pregnant patients diagnosed with pancreatitis during the 21 year period were examined. Most diagnoses occurred in the third trimester (56%). Mean age at presentation was 25.7 years with a mean gestational age of 24.4 weeks. Presentation in most cases was abdominal pain and vomiting with one case of associated hyperemesis gravidarum. Most common etiology was gall stones in 14 (56%), alcohol related in 4 (16%), undetermined in 5 (20%), post-ERCP pancreatitis in 1 (4%), and hereditary in 1 (4%) patient. Triglycerides were minimally high in three patients. ERCP and wireguided sphincterotomy was undertaken in 6/14 (42.8%) patients with gall stone-associated pancreatitis with no complications. 18/25 (72%) women underwent vaginal fullterm delivery, 4 (16%) underwent Cesarean section, and labor was induced in 3 (12%) patients. Recurrence of pancreatitis during the same pregnancy was noted in only one patient. There was no difference in either maternal or fetal outcomes by ERCP status. Conclusion: Acute pancreatitis is rare in pregnancy, occurring most commonly in the third trimester, and gall stones are the most common etiology. Performing ERCP for pancreatitis in pregnancy does not appear to alter maternal or fetal outcomes.