Abstract
Acute pancreatitis in pregnancy is a rare condition estimated to occur in 1 per 1000 to 1 per 12,000 pregnancies. The most frequent etiology in pregnancy is biliary, followed by hyperlipidemia and/or alcohol abuse. Abdominal ultrasound and endoscopic ultrasound are ideal imaging techniques for diagnosing disease because they have no radiation risk. Computed tomography, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangiopancreatography should be used with caution. Treatment could be conservative or surgical, and standard algorithms are slightly modified in pregnant women. In the last decades the outcome of acute pancreatitis in pregnancy is much better, and perinatal mortality is less than 5%.
Highlights
Acute pancreatitis is rare and serious complication during pregnancy, estimated to occur in 1/1000 to 1/12000 pregnancies (Ramin et al, 1995)
Calculation of an amylase to creatinine clearence ratio may be helpful in pregnancy, ratio greater than 5% suggests acute pancreatitis (Augustin&Majerovic, 2007)
Due to the lack of evidence on beneficial effect of antibiotics, an even more conservative approach is recommended in pregnancy
Summary
Acute pancreatitis is rare and serious complication during pregnancy, estimated to occur in 1/1000 to 1/12000 pregnancies (Ramin et al, 1995). The most frequent etiology of acute pancreatitis in pregnancy is biliary caused by gallstones or sludge (Wang et al, 2009). In pregnancy gallstones and sludge induce most of the cases of acute pancreatitis, they cause duct obstruction with pancreatic hyperstimulation that increases pancreatic duct pressure, trypsin reflux and activation of trypsin in the pancreatic acinar cells. This leads to enzyme activation within pancreas and causes autodigestion of the gland, followed by local inflammation. In the third trimester when the acute pancreatitis is most frequent, the uterus is enlarged and intrabdominal pressure on the biliary ducts is increased (Berk et al, 1971)
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