VP31.23: Pregnancy complicated by acute pancreatitis and COVID‐19 infection

Abstract

Acute pancreatitis is a very rare and potentially life threatening complication in pregnancy. Its incidence is 3 per 10,000 pregnancies. We present a case of pregnancy with multiple comorbidities complicated by moderate COVID-19 disease and acute pancreatitis. There have been case reports of COVID-19 infection and acute pancreatitis indicating a possible association between the two. A 34 year-old primigravida at 31-week gestation with dichorionic diamniotic twin pregnancy (IVF conception) presented with complaints of acute epigastric pain radiating to the back with bilious vomiting and breathing difficulty. She had a moderate bout of COVID-19 disease and was referred due to non-availability of intensive care bed. Her pregnancy was also complicated by cholestasis of pregnancy and gestational diabetes mellitus. Patient's condition deteriorated after admission and she was shifted to ICU. Contrast enhanced CT chest and abdomen showed features suggestive of acute pancreatitis with left sided pleural effusion with lower lobe atelectasis. Serum amylase and lipase were raised. Acute pancreatitis was managed conservatively and fine intravenous fluid balance was maintained to prevent worsening of ARDS and to prevent pancreatitis induced acute kidney insult. There was a dilemma, whether to terminate the pregnancy to improve maternal hypoxemia. she underwent emergency Caesarean section for poor biophysical profile with worsening hypoxemia to improve maternal and perinatal outcome. Both babies were admitted to NICU. She developed postpartum psychosis, which was managed in liaison with psychiatrist. Patient's condition improved and she was shifted out of ICU on postoperative day 14. She was discharged in satisfactory condition, after 22 days of hospital stay. Both babies and the mother are currently doing fine and following up in the OPD. To conclude, timely diagnosis, multidisciplinary approach and availability of intensive care facility resulted in optimal outcome of the case.