From acute pancreatitis to pancreonecrosis during pregnancy

Abstract

Acute pancreatitis during pregnancy is a rare but extremely formidable complication and accompanied by a high level of perinatal and maternal mortality. Excessive hypertriglyceridemia is an extremely important risk factor for pancreatitis, especially during pregnancy. The secretion of cholesterol in hepatic bile increases in the second trimester and reaches a peak in the third trimester compared with bile acids and phospholipids, which leads to a supersaturation of bile. This is determines the highest incidence of acute pancreatitis in pregnant women in the third trimester. Acute onset, nature of the disease and difficulties in diagnosis and treatment of acute pancreatitis in pregnant women significantly threaten the health of mother and fetus. Although most authors argue that treating acute pancreatitis during pregnancy is similar to treating non-pregnant patients, this is actually far from the truth. Pathogenesis features of acute pancreatitis in pregnant women come to the fore, which must be taken into account when managing these patients. Medical workers (primarily obstetricians) have a question about the advisability of preserving pregnancy, fetus, timing and method of abortion, and today these are extremely controversial decisions. Management of pregnant women with acute pancreatitis is an extremely difficult task, despite the achievements of recent years, and is accompanied by high perinatal and maternal mortality, the level of which depends on the severity of acute pancreatitis. The severe course of acute pancreatitis in pregnant women is extremely dangerous for the fetus and in all cases leads to its distress and in more than half of cases to fetal loss. The average severity of pancreatitis is also unfavorable for the fetus and is accompanied by its loss in every fourth case. Emergency abortion is indicated if triglycerides are the cause of acute pancreatitis. Management of such pregnant women requires a multidisciplinary approach to predict the course of pancreatitis, determine the tactics of pregnancy and acute pancreatitis, method and timing of delivery.