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Maringhini A, Rossi M, Patti R, Maringhini M, Vassallo V. Acute Pancreatitis during and after Pregnancy: A Review. J Clin Med 2024; 13:2028. [PMID: 38610793 PMCID: PMC11012882 DOI: 10.3390/jcm13072028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/22/2024] [Accepted: 03/24/2024] [Indexed: 04/14/2024] Open
Abstract
During pregnancy and in the post-partum period, several diseases may arise or become exacerbated. Acute pancreatitis is an inflammatory disease with an increasing incidence in Western countries. The incidence of acute pancreatitis during pregnancy is not different with respect to the general population, but this incidence increases in the first 2 years after delivery. Biliary sludge and stones are the most frequent aetiologies, followed by hypertriglyceridemia. Taking care of the mother and foetus through a potentially severe disease requires a team consisting of an obstetrician, a gastroenterologist, an anaesthesiologist, and a surgeon. It is necessary to monitor the health of the foetus/child and the mother during pregnancy, childbirth, and puerperium. The management of this care depends on the systemic and local complications, the severity of the acute pancreatitis, and the trimester of pregnancy. Some diagnostic tools and many drugs are not safe for foetuses, while interventional endoscopy and surgery have limitations and can only be used after an accurate evaluation of benefit/risk ratios. Despite these limitations, maternal mortality due to acute pancreatitis is low during pregnancy, mainly thanks to multidisciplinary approaches for these patients. A careful diet to prevent obesity, alcohol abstinence, routine serum triglyceride control, and breastfeeding for at least three months may prevent acute pancreatitis during and after pregnancy.
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Affiliation(s)
- Alberto Maringhini
- Internal Medicine, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Civico, 90127 Palermo, Italy; (M.R.); (M.M.); (V.V.)
| | - Margherita Rossi
- Internal Medicine, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Civico, 90127 Palermo, Italy; (M.R.); (M.M.); (V.V.)
| | - Rosalia Patti
- Pancreas Unit, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Civico, 90127 Palermo, Italy;
| | - Marco Maringhini
- Internal Medicine, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Civico, 90127 Palermo, Italy; (M.R.); (M.M.); (V.V.)
| | - Valerio Vassallo
- Internal Medicine, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Civico, 90127 Palermo, Italy; (M.R.); (M.M.); (V.V.)
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Morton A. Investigating gastrointestinal disorders in pregnancy. Obstet Med 2024; 17:5-12. [PMID: 38660319 PMCID: PMC11037196 DOI: 10.1177/1753495x231206211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/21/2023] [Accepted: 09/20/2023] [Indexed: 04/26/2024] Open
Abstract
This article reviews anatomical and physiological changes and alterations in reference intervals for laboratory tests in healthy pregnancy, pertinent to investigation of the gastrointestinal system. The safety of procedures and radiological investigations relevant to the investigation of gastrointestinal disorders in pregnancy are also reviewed.
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Affiliation(s)
- Adam Morton
- Mater Health, Raymond Terrace, South Brisbane, QLD, 4101, Australia
- Department of Medicine, University of Queensland, Herston, Brisbane, QLD, 4029, Australia
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Niu C, Zhang J, Zhu K, Liu H, Okolo PI. The hidden dangers of chronic pancreatitis in pregnancy: Evidence from a large-scale population study. Dig Liver Dis 2023; 55:1712-1718. [PMID: 37474413 DOI: 10.1016/j.dld.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/14/2023] [Accepted: 07/03/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Chronic pancreatitis is a debilitating condition that can affect women of childbearing age, and its impact on maternal and perinatal outcomes is poorly understood. AIMS Our findings aim to help healthcare providers counsel pregnant women with chronic pancreatitis and make informed clinical decisions. METHODS In this study, hospital discharge records from the National Inpatient Sample database between 2009 and 2019 were retrospectively analyzed to investigate maternal primary outcomes and primary perinatal outcomes. RESULTS The study findings suggest an association between chronic pancreatitis and elevated rates of gestational diabetes (AOR 1.63, 95% CI 1.19-2.23) and gestational hypertensive complications(AOR 2.48, 95% CI 1.87-3.29). Pregnancies among women with chronic pancreatitis showed an increased likelihood of preterm labor (AOR 3.10, 95% CI 2.40-4.00) and small for gestational age (AOR 2.40, 95% CI 1.35-3.08). Furthermore, it appears that patients with alcohol-induced chronic pancreatitis present a considerably higher risk of fetal death (OR 17.15, 95% CI 2.29-128.26). The study also revealed that those chronic pancreatitis patients with a history of chronic renal failure could be more prone to developing gestational hypertensive complications (OR 20.09, 95%CI 2.07-194.93). Moreover, associations were observed between chronic pancreatitis pregnancies and lengthier hospital stays as well as elevated hospital costs. CONCLUSIONS Our research has uncovered a heightened risk of complications associated with chronic pancreatitis for mothers and fetuses. The implications of our findings are critical for healthcare professionals, particularly those involved in preconception counseling.
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Affiliation(s)
- Chengu Niu
- Internal Medicine Residency Program, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY 14621, USA.
| | - Jing Zhang
- Harbin Medical University, Harbin 150081, China
| | - Kaiwen Zhu
- Internal Medicine Residency Program, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY 14621, USA
| | - Hongli Liu
- Internal Medicine Residency Program, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY 14621, USA
| | - Patrick I Okolo
- Division of Gastroenterology, Rochester General Hospital, Rochester, NY 14621, USA
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Niu C, Zhang J, Liu H, Zhu K, Okolo PI. Maternal and fetal outcomes of acute pancreatitis in pregnancy: a population-based study. Eur J Gastroenterol Hepatol 2023; 35:1354-1361. [PMID: 37851097 DOI: 10.1097/meg.0000000000002665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND Acute pancreatitis during pregnancy can have negative effects on both the mother and the fetus. The primary aim of this study is to evaluate the trends, maternal and fetal outcomes, and associated comorbidities of acute pancreatitis during pregnancy using data from the USA National Inpatient Sample (NIS) database. METHODS This study is a retrospective analysis of hospital discharge records from the NIS database from 2009 to 2019. RESULTS Delivery patients with acute pancreatitis faced a higher risk of maternal mortality (AOR 91.02, 95% CI 28.47-291.06), postpartum hemorrhage (AOR 1.59, 95% CI 1.02-2.49), and hypertensive complications (defined as preeclampsia, eclampsia, or HELLP syndrome) (AOR 3.42, 95% CI 2.56-4.56) compared to those without acute pancreatitis. Moreover, we saw an increased incidence of preterm labor (AOR 3.94, 95% CI 3.02-5.12) and fetal death (AOR 3.12, 95% CI 1.76-5.53). Rates of fetal restriction and large fetal size were comparable. Additionally, the acute pancreatitis group showed higher rates of acute kidney injury (4.2% vs. 0.06%; AOR, 31.02, 95% CI 12.50-76.98), severe sepsis (0.8% vs. 0.01%; AOR, 34.49, 95% CI 7.67-155.14), and respiratory failure (2.4% vs. 0.06%; AOR, 20.77, 95% CI (8.55-50.41). There were no significant differences in maternal and perinatal outcomes in biliary pancreatitis after the intervention compared to conservative treatment. CONCLUSION Acute pancreatitis during pregnancy can have negative effects on both the mother and fetus. Treatment for biliary pancreatitis does not affect maternal and fetal outcomes. An interdisciplinary approach is essential to ensure optimal outcomes for mothers and their offspring in these cases.
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Affiliation(s)
- Chengu Niu
- Internal medicine residency program, Rochester General Hospital, Rochester, New, USA
| | - Jing Zhang
- Harbin Medical University, Harbin, China
| | - Hongli Liu
- Internal medicine residency program, Rochester General Hospital, Rochester, New, USA
| | - Kaiwen Zhu
- Internal medicine residency program, Rochester General Hospital, Rochester, New, USA
| | - Patrick I Okolo
- Division of Gastroenterology, Rochester General Hospital, Rochester, New York, USA
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5
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Ameerah Y, Musmar B, Awadghanem A, Abdo Q. Autoimmune pancreatitis with IgG-4 cholangiopathy in a pregnant woman: A case report. Radiol Case Rep 2023; 18:1580-1584. [PMID: 36845283 PMCID: PMC9947181 DOI: 10.1016/j.radcr.2023.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 02/12/2023] Open
Abstract
Diagnosis and management of autoimmune pancreatitis during pregnancy. Autoimmune pancreatitis is a rare and life-threatening condition with increased maternal and fetal morbidity and mortality. Autoimmune pancreatitis may result in a mass-forming lesion in the pancreas resembling pancreatic cancer; therefore, meticulous and careful investigations must be done to avoid misdiagnosing autoimmune pancreatitis as pancreatic cancer. Since autoimmune pancreatitis improves dramatically to steroid therapy, accurate diagnosis of autoimmune pancreatitis can avoid unnecessary procedures, surgeries, and pancreatic resection. A case of a pregnant lady in her third trimester was presented with abdominal pain, nausea, and vomiting. On examination, there was tenderness in both epigastric and right hypochondrium associated with elevated serum amylase, liver transaminases, alkaline phosphatase, gamma-glutamyl transpeptidase, and immunoglobulin G4. Both abdominal ultrasound and magnetic resonance cholangiopancreatography showed a pancreatic head lesion with dilation in both pancreatic duct and common bile duct. Steroid was initiated that resulted in rapid and dramatic responsiveness. Acute pancreatitis is uncommon during pregnancy, and autoimmune pancreatitis is a very rare form of acute pancreatitis; therefore, a clear and rapid assessment, diagnosis, and management plan are necessary to avoid maternal and fetal morbidity and mortality.
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Affiliation(s)
- Yara Ameerah
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine,Corresponding author.
| | - Basel Musmar
- School of Medicine, An-Najah National University, Nablus, Palestine
| | - Ahmed Awadghanem
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine,Department of Radiology, An-Najah National University Hospital, Nablus, Palestine
| | - Qusai Abdo
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine,Department of Gastroenterology, An-Najah National University Hospital, Nablus, Palestine
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Haiyan Z, Na P, Yong G, Xiumei B, Jianying B. Impact of acute pancreatitis during pregnancy in Chinese women: a meta-analysis. J OBSTET GYNAECOL 2022; 42:2879-2887. [PMID: 35993525 DOI: 10.1080/01443615.2022.2110462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A random-effects meta-analysis was performed in English and Chinese databases since its inception to August 2020 to assess the incidence, causes and severity of acute pancreatitis (AP) at various stages of pregnancy, maternal and foetal mortality. A total of 154 articles representing 4034 patients with AP during pregnancy in China were included for the analysis. The incidence of AP during pregnancy was 0.0469 (95% confidence interval [CI], 0.0349; 0.0627) in the first trimester, whereas it was 0.2518 (95% CI, 0.2210; 0.2854) and 0.6323 (95% CI, 0.5870; 0.6753) in the second and third trimester, respectively. The major causes of AP were hypertriglyceridaemia (0.351 [95% CI, 0.3202; 0.3834]) and biliary pancreatitis (0.424 [95% CI, 0.4094; 0.5002]). The severity of AP was mild in majority of the patients. The incidence of AP at maternal mortality was 0.0184 (95% CI, 0.0126; 0.0269) and foetal mortality was 0.1018 (95% CI, 0.0867; 0.1192). Our meta-analysis revealed that hypertriglyceridaemia and biliary pancreatitis remain the major causes of AP during pregnancy. Foetal mortality requires further investigation. IMPACT STATEMENTWhat is already known on this subject? Acute pancreatitis (AP) in pregnant women is characterised by acute onset and delay in understanding the interaction of the metabolic changes with pancreatic pathophysiology, and thus becomes difficult to diagnose the disease and provide timely treatment to the patients. This poses a greater health risk among women and their foetus by increasing their chances of mortality.What the results of this study add? We performed an exhaustive, random-effects meta-analysis involving 154 articles representing 4034 patients to assess the incidence of AP at various stages of pregnancy, the causes of AP and the severity of AP during pregnancy, maternal and foetal mortality.What are the implications of these findings for clinical practice and/or further research? Our meta-analysis revealed that hypertriglyceridaemia and biliary pancreatitis remain the major causes of AP during pregnancy. Although the rates of maternal mortality have decreased in the recent years, foetal mortality still remains high and requires further investigation.
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Affiliation(s)
- Zhao Haiyan
- Department of Gastroenterology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Peng Na
- Department of Obstetrics and Gynecology, Affiliated Hospital of Chongqing Institute of Population and Family Planning Science and Technology, Chongqing, China
| | - Gao Yong
- Department of Gastroenterology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Bai Xiumei
- Department of Gastroenterology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Bai Jianying
- Department of Gastroenterology, Second Affiliated Hospital of Army Medical University, Chongqing, China
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Dey RK, Ilango H, Bhatta S, Shaheed A, Dole S, Zooshan A, Faisham M, Murad M. Acute pancreatitis in pregnancy following COVID-19 vaccine: a case report. J Med Case Rep 2022; 16:354. [PMID: 36175940 PMCID: PMC9521872 DOI: 10.1186/s13256-022-03607-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 09/05/2022] [Indexed: 11/21/2022] Open
Abstract
Background Since the approval of the Pfizer–BioNTech (BNT162b2) mRNA vaccine for COVID-19 infection, a few adverse effects have been reported. Acute pancreatitis has been reported in a few patients. However, there is currently no research showing a direct relationship between the vaccine and acute pancreatitis. Here, we report a case of acute pancreatitis following Pfizer vaccination in a young healthy pregnant woman without any known risk factors. To our knowledge, this is the first case report of possible vaccine-induced pancreatitis in a pregnant woman.
Case presentation The patient, a 24-year-old South-Asian female, at 31 weeks of gestation, presented with severe epigastric pain radiating to the back and worsening on lying supine, associated with nausea and vomiting. She was diagnosed with acute pancreatitis with a serum lipase level of 4376 U/L and an ultrasound showing features of pancreatitis. The patient received her first dose of the Pfizer vaccine 1 week prior to these symptoms. Detailed evaluation did not show any etiological cause of pancreatitis. The patient had a spontaneous vaginal delivery and the baby was shifted to the neonatal intensive care unit in a stable condition. A computed tomography scan postpartum (day 2) demonstrated acute interstitial edematous pancreatitis. The patient was managed conservatively in the intensive care unit and discharged home in a stable condition. Conclusion This report highlights the importance of a detailed history and evaluation, and the close monitoring of any patient presenting with abdominal pain after vaccination. Acute pancreatitis can be fatal if not picked up early.
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Affiliation(s)
- Rajib Kumar Dey
- Department of Internal medicine, Indira Gandhi Memorial Hospital, Male', Maldives.
| | - Hemamala Ilango
- Department of Gastroenterology, Indira Gandhi Memorial Hospital, Male', Maldives
| | - Subash Bhatta
- Department of Otolaryngology, Indira Gandhi Memorial Hospital, Male', Maldives
| | - Ahmed Shaheed
- Department of Internal medicine, Indira Gandhi Memorial Hospital, Male', Maldives
| | - Shanaz Dole
- Department of Obstetrics and Gynaecology, Indira Gandhi Memorial Hospital, Male', Maldives
| | - Ahmed Zooshan
- Department of Internal medicine, Indira Gandhi Memorial Hospital, Male', Maldives
| | - Mohamed Faisham
- Department of Internal medicine, Indira Gandhi Memorial Hospital, Male', Maldives
| | - Moosa Murad
- Department of Internal medicine, Indira Gandhi Memorial Hospital, Male', Maldives
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Epidural Analgesia for Pain Management in Acute Pancreatitis during Pregnancy and Its Effect on Maternal and Fetal Outcome. Obstet Gynecol Int 2022; 2022:3238613. [PMID: 36157323 PMCID: PMC9492404 DOI: 10.1155/2022/3238613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/26/2022] [Accepted: 07/23/2022] [Indexed: 11/22/2022] Open
Abstract
Background Acute pancreatitis (AP) during pregnancy is a rare presentation with an estimated incidence of 1 case per 1000 to 10,000 pregnancies. Severe epigastric and abdominal pain is the earliest and the most common symptom of AP, and adequate pain relief is an integral part of patient management. The aim of our study was to investigate the different pain relief modalities that are used in pregnant women with AP and the efficacy of each method used, in terms of better pain relief and maternal-fetal outcomes. Methods This was a retrospective observational study over a period of 6 years conducted at a tertiary care hospital. Pregnant women with clinical and biochemical diagnoses of acute pancreatitis were included in the study. Patient's history and clinical and biochemical data were collected from the medical records of the hospital. Results A total of 12 patients were included in the study, 5 out of 12 patients had gall stones associated with AP, 2 patients had hypertriglyceridemia, and 1 each had preeclampsia and eclampsia. Epidural analgesia at the level of L1-L2 spinal level showed a reduction of VAS scores from 8 or 9 to 1 or 2, indicating excellent pain as compared to t intravenous (i/v) infusion of fentanyl or i/v boluses of injection tramadol, in whom VAS was never reduced below 3. With satisfactory results, labour analgesia and anesthesia for caesarean section was provided via the same catheter in 2 and 3 patients, respectively. Maternal and fetal outcomes were comparable in all the patients. Conclusion AP in pregnancy, when diagnosed early and managed accordingly, leads to better maternal and fetal outcomes. Epidural analgesia was better than intravenous analgesia in terms of pain management and better recovery of acute pancreatitis patients. In these patients, labour analgesia and anesthesia for caesarean section can be provided through the same catheter, making it a potential novel modality in the treatment of acute pancreatitis in pregnancy.
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Szatmary P, Grammatikopoulos T, Cai W, Huang W, Mukherjee R, Halloran C, Beyer G, Sutton R. Acute Pancreatitis: Diagnosis and Treatment. Drugs 2022; 82:1251-1276. [PMID: 36074322 PMCID: PMC9454414 DOI: 10.1007/s40265-022-01766-4] [Citation(s) in RCA: 88] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 11/11/2022]
Abstract
Acute pancreatitis is a common indication for hospital admission, increasing in incidence, including in children, pregnancy and the elderly. Moderately severe acute pancreatitis with fluid and/or necrotic collections causes substantial morbidity, and severe disease with persistent organ failure causes significant mortality. The diagnosis requires two of upper abdominal pain, amylase/lipase ≥ 3 ×upper limit of normal, and/or cross-sectional imaging findings. Gallstones and ethanol predominate while hypertriglyceridaemia and drugs are notable among many causes. Serum triglycerides, full blood count, renal and liver function tests, glucose, calcium, transabdominal ultrasound, and chest imaging are indicated, with abdominal cross-sectional imaging if there is diagnostic uncertainty. Subsequent imaging is undertaken to detect complications, for example, if C-reactive protein exceeds 150 mg/L, or rarer aetiologies. Pancreatic intracellular calcium overload, mitochondrial impairment, and inflammatory responses are critical in pathogenesis, targeted in current treatment trials, which are crucially important as there is no internationally licenced drug to treat acute pancreatitis and prevent complications. Initial priorities are intravenous fluid resuscitation, analgesia, and enteral nutrition, and when necessary, critical care and organ support, parenteral nutrition, antibiotics, pancreatic exocrine and endocrine replacement therapy; all may have adverse effects. Patients with local complications should be referred to specialist tertiary centres to guide further management, which may include drainage and/or necrosectomy. The impact of acute pancreatitis can be devastating, so prevention or reduction of the risk of recurrence and progression to chronic pancreatitis with an increased risk of pancreas cancer requires proactive management that should be long term for some patients.
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Affiliation(s)
- Peter Szatmary
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Tassos Grammatikopoulos
- Paediatric Liver, GI and Nutrition Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Wenhao Cai
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,West China Centre of Excellence for Pancreatitis and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Huang
- West China Centre of Excellence for Pancreatitis and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Rajarshi Mukherjee
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Department of Molecular Physiology and Cell Signalling, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool , UK
| | - Chris Halloran
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Georg Beyer
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Robert Sutton
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK. .,Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK. .,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
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Stanley AD, Tembelis M, Patlas MN, Moshiri M, Revzin MV, Katz DS. Magnetic Resonance Imaging of Acute Abdominal Pain in the Pregnant Patient. Magn Reson Imaging Clin N Am 2022; 30:515-532. [PMID: 35995477 DOI: 10.1016/j.mric.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Evaluation of a pregnant patient presenting with acute abdominal pain can be challenging to accurately diagnose for a variety of reasons, and particularly late in pregnancy. Noncontrast MR remains a safe and accurate diagnostic imaging modality for the pregnant patient presenting with acute abdominal pain, following often an initially inconclusive ultrasound examination, and can be used in most settings to avoid the ionizing radiation exposure of a computed tomography scan. Pathologic processes discussed in this article include some of the more common gastrointestinal, hepatobiliary, genitourinary, and gynecologic causes of abdominal pain occurring in pregnancy, as well as traumatic injuries.
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Affiliation(s)
- Abigail D Stanley
- NYIT College of Osteopathic Medicine, Old Westbury, 101 Northern Boulvard, Glen Head, NY 11545, USA.
| | - Miltiadis Tembelis
- Department of Radiology, NYU Langone Hospital, 222 Station Plaza North, Suite 501, Mineola, NY 11501, USA
| | - Michael N Patlas
- Department of Radiology, McMaster University, Hamilton General Hospital, 237 Barton Street, East Hamilton, ON L8L 2X2, Canada
| | - Mariam Moshiri
- Department of Radiology, Vanderbilt University Medical Center, 1161-21st Avenue, South Medical Center North CCC-117, Nashville, TN 37232, USA
| | - Margarita V Revzin
- Department of Radiology and Biomedical Imaging, Yale University, 330 Cedar Street, New Haven, CT 06520, USA
| | - Douglas S Katz
- Department of Radiology, NYU Langone Hospital, 222 Station Plaza North, Suite 501, Mineola, NY 11501, USA
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11
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Zhang GF, Yu XQ, Hu YP, Yang Q, Li WQ. Progress in research of acute pancreatitis in pregnancy. Shijie Huaren Xiaohua Zazhi 2022; 30:541-546. [DOI: 10.11569/wcjd.v30.i12.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Acute pancreatitis in pregnancy (APIP) is a rare and severe complication of pregnancy, which is characterized by rapid onset, rapid progression, many complications, and high mortality. According to previous studies, the incidence of APIP is about 1/10000-1/1000 and increases with gestational age. Due to the differences in genetic background and dietary habits between Asian and European populations, the incidence of APIP in China is as high as 1.14‰-2.27‰, significantly higher than that in Western countries. The lack of specific clinical symptoms of APIP often leads to misdiagnosis or missed diagnosis, which greatly increases the difficulty of diagnosis and treatment. Despite the deepening of the research on APIP, its pathogenesis is still unclear. This paper will give a systematical review of APIP.
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Affiliation(s)
- Guo-Fu Zhang
- Department of Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Xian-Qiang Yu
- Medical College of Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Yue-Peng Hu
- Department of Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Qi Yang
- Department of Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Wei-Qin Li
- Department of Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China,Medical College of Southeast University, Nanjing 210009, Jiangsu Province, China,Department of Critical Care Medicine, General Hospital of Eastern Theater Command, Nanjing 210002, Jiangsu Province, China
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12
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Acute Pancreatitis in Pregnancy: A Ten-Year Noninterventional, Retrospective Cohort Experience. Gastroenterol Res Pract 2022; 2022:3663079. [PMID: 35721824 PMCID: PMC9203233 DOI: 10.1155/2022/3663079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/27/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022] Open
Abstract
Background The study is aimed at evaluating the clinical attributes, types, and risk factors associated with poor outcomes in women with acute pancreatitis (AP) during pregnancy. Methods From 2011 to 2020, 45 antenatal mothers with AP were included in this noninterventional, retrospective study. The correlation between etiology of AP, its severity, biochemical parameters, length of stay, and treatment was analyzed. Based on the presence of organ failure and systemic complications, the severity of AP was classified according to the revised Atlantic criteria. Results In total, 19 (42.2%), 15 (33.3%), and 11 (24.2%) patients had mild AP (MAP), moderately severe AP (MSAP), and severe AP (SAP), respectively. The major cause of AP in these patients was hypertriglyceridemia (26.6%), while only 2 (4.44%) suffered from biliary pancreatitis. The median length of stay at hospital was significantly longer in patients with SAP (P = 0.034), and these patients had significantly higher triglycerides and total cholesterol levels when compared to MAP and MSAP. It was observed that levels of liver function enzymes such as alanine aminotransferase serum levels and aspartate aminotransferase serum levels were significantly higher in patients who stayed in hospital for >13 days. The presence of hypertriglyceridemia significantly increased the duration of stay (>13 days, P = 0.04) and induced SAP (P = 0.001). Majority of patients with SAP received blood purification than those with MAP and MSAP (P < 0.001). Conclusion Hypertriglyceridemia was associated with AP during pregnancy in our study. Early diagnosis of AP and assessment of its severity are very important for the general management of this disease.
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Zhang T, Wang G, Cao Z, Huang W, Xiao H, Wei H, Lu J, Liu R, Yin C. Acute pancreatitis in pregnancy: a 10-year, multi-center, retrospective study in Beijing. BMC Pregnancy Childbirth 2022; 22:414. [PMID: 35581621 PMCID: PMC9115992 DOI: 10.1186/s12884-022-04742-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Acute pancreatitis in pregnancy (APIP) is a rare and serious complication during pregnancy. It has acute onset and is difficult to diagnose and treat. The aim of the present study was to describe the etiology, clinical manifestations, and maternofetal outcomes of APIP. METHODS We retrospectively reviewed 32 pregnant women who were treated at three tertiary care hospitals in Beijing, China. The correlation between the causes of APIP, severity, laboratory indices, and outcomes was analyzed. RESULTS The most common causes of APIP were hypertriglyceridemia (56.2%,18/32) and gallstones (28.1%, 9/32). Hypertriglyceridemia-induced APIP was associated with a higher rate of severe acute pancreatitis (P = 0.025). Serum level of triglycerides showed a positive correlation with the severity of APIP (P = 0.039). The most frequent presentation of APIP was abdominal pain (93.7%, 30/32). There were no maternal or fetal deaths in our study. Apgar scores at 1 min, 5 min, and 10 min of the premature neonates was correlated with the severity of APIP of the mother (P = 0.022; 0.002; 0.002). CONCLUSION High level of triglycerides may serve as a useful marker of the severity of APIP. The severity of APIP was associated with higher risk of neonate asphyxia. Appropriate timing of termination of pregnancy is a key imperative for APIP patients.
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Affiliation(s)
- Tingting Zhang
- Department of Internal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Guoxing Wang
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zheng Cao
- Department of Clinical Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Wenyang Huang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hongli Xiao
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hongtao Wei
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Junli Lu
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, People's Republic of China.
| | - Ruixia Liu
- Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Chaoyang District, Beijing, 100026, People's Republic of China.
| | - Chenghong Yin
- Department of Internal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Chaoyang District, Beijing, 100026, People's Republic of China.
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Shrimanker TV, Retalis Z, Hussein KI. Hypertriglyceridemia-induced pancreatitis after egg retrieval for in vitro fertilization and fenofibrate cessation. Clin Case Rep 2022; 10:e05874. [PMID: 35592051 PMCID: PMC9097723 DOI: 10.1002/ccr3.5874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/09/2022] [Accepted: 04/22/2022] [Indexed: 12/19/2022] Open
Abstract
A 36-year-old woman with prior hypertriglyceridemia-induced pancreatitis presented with a recurrence of pancreatitis after beginning in vitro fertilization (IVF). Her primary care physician had discontinued fenofibrate due to concerns for teratogenicity. This case illustrates the importance of fibrate therapy for high-risk women undergoing IVF, despite limited evidence regarding its teratogenicity.
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Affiliation(s)
- Tushaar V. Shrimanker
- Department of MedicineGreenwich HospitalYale‐New Haven Health SystemGreenwichConnecticutUSA
| | - Zachary Retalis
- Department of MedicineGreenwich HospitalYale‐New Haven Health SystemGreenwichConnecticutUSA
| | - Khalil Ian Hussein
- Department of MedicineGreenwich HospitalYale‐New Haven Health SystemGreenwichConnecticutUSA
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15
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Chronic Pancreatitis in Females is Not Associated With Adverse Pregnancy Outcomes: A Retrospective Analysis. J Clin Gastroenterol 2022; 57:531-536. [PMID: 35470319 DOI: 10.1097/mcg.0000000000001711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/18/2022] [Indexed: 12/10/2022]
Abstract
BACKGROUND The effects of chronic pancreatitis (CP) on pregnancy and vice versa have not been studied well. We aimed to study the impact of CP on pregnancy-related outcomes and the effect of pregnancy on clinical profile of CP. STUDY AND GOALS We did a retrospective analysis of all female patients of CP of child-bearing age (above 18 y). The pregnancy-related outcomes of patients with CP were compared with the age-matched 115 controls from the low-risk pregnancy group identified using a simplified antepartum high-risk pregnancy scoring form. The clinical course of CP during pregnancy was compared with the pre-pregnancy course. RESULTS Among the 338 eligible patients, 46 patients were included after exclusions. All these 46 patients had at least 1 conception and 41 had at least 1 completed pregnancy with a total of 117 conceptions and 96 completed pregnancies. The pregnancy-related outcomes in patients with CP like abortions (21.7% vs. 11.3%;P=0.087), preterm deliveries (14.6% vs. 10.4%;P=0.47), antepartum course (82.7% vs. 82.6%;P=0.58), stillbirths (4.9% vs. 4.3%;P=0.88), cesarean section (36.6% vs. 34%;P=0.849) were comparable with controls. There was overall improvement in the severity and frequency of pain during pregnancy as compared with the pre-pregnancy symptoms (P=0.001). CONCLUSION CP is not associated with adverse pregnancy outcomes. Also, there is trend toward improvement in the clinical symptoms because of CP during the pregnancy.
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Kambayashi K, Toki M, Watanabe S, Hisamatsu T. Management of common bile duct stones in a pregnant woman by percutaneous biliary drainage followed by elective endoscopic stone removal after delivery. BMJ Case Rep 2022; 15:15/3/e248285. [PMID: 35321915 PMCID: PMC8943743 DOI: 10.1136/bcr-2021-248285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A woman in her 30s who was 12 weeks pregnant with her third child presented with jaundice. Blood tests showed elevated hepatobiliary enzymes and direct bilirubin. Abdominal ultrasonography showed dilatation of the common bile duct and strong echo with a 9 mm acoustic shadow in the distal bile duct. She was diagnosed with common bile duct stone disease and biliary drainage was considered necessary. Percutaneous transhepatic biliary drainage (PTBD) was performed considering the effect on both the fetus and the mother, and the procedure was successful without any complications. The PTBD tube was left in place until delivery at 36 weeks 6 days of gestation and endoscopic stone removal was performed 14 days after delivery. The patient was discharged 18 days after delivery without any complications. In pregnant women with common bile duct stones, palliative PTBD followed by elective endoscopic stone removal after delivery can be considered a treatment strategy.
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Affiliation(s)
- Komei Kambayashi
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Mitaka-shi, Tokyo, Japan
| | - Masao Toki
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Mitaka-shi, Tokyo, Japan
| | - Shunsuke Watanabe
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Mitaka-shi, Tokyo, Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Mitaka-shi, Tokyo, Japan
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17
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Kumar-M P, Singh AK, Samanta J, Birda CL, Kumar N, Dhar J, Gupta P, Kochhar R. Acute pancreatitis in pregnancy and its impact on the maternal and foetal outcomes: A systematic review. Pancreatology 2022; 22:210-218. [PMID: 34961727 DOI: 10.1016/j.pan.2021.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 11/13/2021] [Accepted: 12/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The prevalence of AP in pregnancy (APIP) is uncertain with varying reports of its impact on maternal and foetal outcomes. OBJECTIVES This study was aimed to find the prevalence of APIP and its effect on the maternal and foetal outcomes. SEARCH STRATEGY Electronic databases were searched upto 31.05.2020 for the appropriate studies. SELECTION CRITERIA Prospective, retrospective observational studies or case series evaluating APIP in terms of maternal and foetal outcomes were included. DATA COLLECTION AND ANALYSIS Data on the prevalence of APIP, etiology, maternal mortality rates and foetal outcomes were collated. Due to high heterogeneity among the studies, the data has been represented as a systematic review. RESULTS A total of 16 studies with 8466 pregnant patients were included in the systematic review. The overall prevalence of APIP ranged from 0.225/1000 pregnancies to 2.237/1000 pregnancies. Gallstone disease was the most common cause ranging from 14.29 to 96.3%, with eastern studies reporting more cases of hypertriglyceridemia as etiology. Mild pancreatitis was noted in 33.33-100% of cases with milder disease among western studies. APIP incidence was higher during 3rd trimester (27.27%-95.24%). Maternal mortality ranged from 0 to 12.12/100 pregnancies. Foetal loss ranged from 0 to 23.08%, with adverse foetal outcomes ranging from 0 to 57.41%. Neonatal mortality ranged from 0 to 75.5/1000 neonatal live birth. CONCLUSION APIP is usually mild, but its incidence increases with gestational age. Maternal outcome is usually good but adverse foetal outcome is high in APIP (PROSPERO No.: CRD42020194313).
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Affiliation(s)
| | | | | | | | - Naveen Kumar
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - Jahnvi Dhar
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - Pankaj Gupta
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, PGIMER, Chandigarh, India
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Cai E, Czuzoj-Shulman N, Abenhaim HA. Perinatal outcomes in pregnancies complicated by acute pancreatitis. J Perinat Med 2022; 50:68-73. [PMID: 34523294 DOI: 10.1515/jpm-2020-0580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 08/11/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Acute pancreatitis is a rare condition that can be associated with significant complications. The objective of this study is to evaluate the maternal and newborn outcomes associated with acute pancreatitis in pregnancy. METHODS A retrospective cohort study using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from the United States was performed. All pregnant patients with acute pancreatitis were identified using International Classification of Disease-9 coding from 1999 to 2015. The effect of acute pancreatitis on maternal and neonatal outcomes in pregnancy was evaluated using multivariate logistic regression, while adjusting for baseline maternal characteristics. RESULTS From 1999 to 2015, there were a total of 13,815,919 women who gave birth. There were a total of 14,258 admissions of women diagnosed with acute pancreatitis, including 1,756 who delivered during their admission and 12,502 women who were admitted in the antepartum period and did not deliver during the same admission. Acute pancreatitis was associated with increased risk of prematurity, OR 3.78 (95% CI 3.38-4.22), preeclampsia, 3.81(3.33-4.36), postpartum hemorrhage, 1.90(1.55-2.33), maternal death, 9.15(6.05-13.85), and fetal demise, 2.60(1.86-3.62) among women diagnosed with acute pancreatitis. Among women with acute pancreatitis, delivery was associated with increased risk of requiring transfusions, 6.06(4.87-7.54), developing venous thromboembolisms, 2.77(1.83-4.18), acute respiratory failure, 3.66(2.73-4.91), and disseminated intravascular coagulation, 8.12(4.12-16.03). CONCLUSIONS Acute pancreatitis in pregnancy is associated with severe complications, such as maternal and fetal death. Understanding the risk factors that may lead to these complications can help prevent or minimize them through close fetal and maternal monitoring.
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Affiliation(s)
- Emmy Cai
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | | | - Haim A Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada.,Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, QC, Canada
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Bendarska-Czerwińska A, Zmarzły N, Morawiec E, Panfil A, Bryś K, Czarniecka J, Ostenda A, Dziobek K, Sagan D, Boroń D, Michalski P, Pallazo-Michalska V, Grabarek BO. Endocrine disorders and fertility and pregnancy: An update. Front Endocrinol (Lausanne) 2022; 13:970439. [PMID: 36733805 PMCID: PMC9887196 DOI: 10.3389/fendo.2022.970439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
It is estimated that more and more couples suffer from fertility and pregnancy maintenance disorders. It is associated with impaired androgen secretion, which is influenced by many factors, ranging from genetic to environmental. It is also important to remember that fertility disorders can also result from abnormal anatomy of the reproductive male and female organ (congenital uterine anomalies - septate, unicornuate, bicornuate uterus; acquired defects of the uterus structure - fibroids, polyps, hypertrophy), disturbed hormonal cycle and obstruction of the fallopian tubes resulting from the presence of adhesions due to inflammation, endometriosis, and surgery, abnormal rhythm of menstrual bleeding, the abnormal concentration of hormones. There are many relationships between the endocrine organs, leading to a chain reaction when one of them fails to function properly. Conditions in which the immune system is involved, including infections and autoimmune diseases, also affect fertility. The form of treatment depends on infertility duration and the patient's age. It includes ovulation stimulation with clomiphene citrate or gonadotropins, metformin use, and weight loss interventions. Since so many different factors affect fertility, it is important to correctly diagnose what is causing the problem and to modify the treatment regimen if necessary. This review describes disturbances in the hormone secretion of individual endocrine organs in the context of fertility and the maintenance of pregnancy.
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Affiliation(s)
- Anna Bendarska-Czerwińska
- Department of Molecular, Biology Gyncentrum Fertility Clinic, Katowice, Poland
- Faculty of Medicine, Academy of Silesia, Zabrze, Poland
- American Medical Clinic, Katowice, Poland
- *Correspondence: Anna Bendarska-Czerwińska, ; Nikola Zmarzły, ; Beniamin Oskar Grabarek,
| | - Nikola Zmarzły
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine, University of Technology, Academy of Silesia in Katowice, Zabrze, Poland
- *Correspondence: Anna Bendarska-Czerwińska, ; Nikola Zmarzły, ; Beniamin Oskar Grabarek,
| | - Emilia Morawiec
- Department of Molecular, Biology Gyncentrum Fertility Clinic, Katowice, Poland
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine, University of Technology, Academy of Silesia in Katowice, Zabrze, Poland
- Department of Microbiology, Faculty of Medicine, University of Technology, Academy of Silesia in Katowice, Zabrze, Poland
| | - Agata Panfil
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine, University of Technology, Academy of Silesia in Katowice, Zabrze, Poland
| | - Kamil Bryś
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine, University of Technology, Academy of Silesia in Katowice, Zabrze, Poland
| | - Justyna Czarniecka
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine, University of Technology, Academy of Silesia in Katowice, Zabrze, Poland
| | | | | | - Dorota Sagan
- Medical Center Dormed Medical SPA, Busko-Zdroj, Poland
| | - Dariusz Boroń
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine, University of Technology, Academy of Silesia in Katowice, Zabrze, Poland
- Department of Gynaecology and Obstetrics, Faculty of Medicine, Academy of Silesia, Zabrze, Poland
- Department of Gynecology and Obstetrics with Gynecologic Oncology, Ludwik Rydygier Memorial Specialized Hospital, Kraków, Poland
- Department of Gynecology and Obstetrics, TOMMED Specjalisci od Zdrowia, Katowice, Poland
| | | | | | - Beniamin Oskar Grabarek
- Department of Molecular, Biology Gyncentrum Fertility Clinic, Katowice, Poland
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine, University of Technology, Academy of Silesia in Katowice, Zabrze, Poland
- Department of Gynaecology and Obstetrics, Faculty of Medicine, Academy of Silesia, Zabrze, Poland
- Department of Gynecology and Obstetrics with Gynecologic Oncology, Ludwik Rydygier Memorial Specialized Hospital, Kraków, Poland
- Department of Gynecology and Obstetrics, TOMMED Specjalisci od Zdrowia, Katowice, Poland
- *Correspondence: Anna Bendarska-Czerwińska, ; Nikola Zmarzły, ; Beniamin Oskar Grabarek,
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20
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Maringhini A, Dardanoni G, Fantaci G, Patti R, Maringhini M. Acute Pancreatitis During and After Pregnancy: Incidence, Risk Factors, and Prognosis. Dig Dis Sci 2021; 66:3164-3170. [PMID: 33085013 DOI: 10.1007/s10620-020-06608-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acute pancreatitis may complicate pregnancy and both are associated with gallstones, but its incidence is not well known. AIMS To validate hospital discharge records in diagnosing acute pancreatitis and gallstones and to evaluate acute pancreatitis incidence in non pregnant, pregnant and after delivery using hospital discharge records METHODS: We identified all hospital discharge records of hospitalized Sicilian women of childbearing age (2011-2016). We determined agreement between 300 hospital discharge records and hospital records in diagnosing acute pancreatitis and gallstones. Acute pancreatitis incidence, prognosis, and their relationship with age and gallstones were calculated in the three groups using hospital discharge records. RESULTS There was 92% and 88% agreement in diagnosing acute pancreatitis and gallstones between hospital discharge and hospital records. In non pregnant, 1,564 of 7,236,863 women-years (21.61/100,000 person-years) developed acute pancreatitis. During pregnancy, 34 of 226,492 women-years developed acute pancreatitis (20.02/100,000 person-years). Postpartum acute pancreatitis incidence was higher than non pregnant, only in the first 2 years with the peak in the first semester (95.4/100,000 person-years). The increased incidence of postpartum acute pancreatitis was associated with gallstones in youngest women (gallstones acute pancreatitis in women below 20 years old versus non pregnant: rate ratios 16.61; 95% CI 8.40-32.87). CONCLUSIONS Agreement in acute pancreatitis and gallstones diagnosis between hospital discharge and hospital records was accurate. Acute pancreatitis incidence was increased only in the first 2 years after delivery in young women with gallstones.
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Affiliation(s)
- Alberto Maringhini
- Dipartimento Medicina, ARNAS Ospedale Civico, Piazza Nicola Leotta 4, 90127, Palermo, Italy.
| | - Gabriella Dardanoni
- Dipartimento per le Attività Sanitarie ed Osservatorio Epidemiologico, Regione Sicilia, Via Vaccaro, 5, 90145, Palermo, Italy
| | - Giovanna Fantaci
- Dipartimento per le Attività Sanitarie ed Osservatorio Epidemiologico, Regione Sicilia, Via Vaccaro, 5, 90145, Palermo, Italy
| | - Rosalia Patti
- Dipartimento Medicina, ARNAS Ospedale Civico, Piazza Nicola Leotta 4, 90127, Palermo, Italy
| | - Marco Maringhini
- Dipartimento di Medicina Interna, Università di Palermo, Via del Vespro 129, 90127, Palermo, Italy
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21
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Pancreatic Disorders of Pregnancy. Clin Obstet Gynecol 2021; 63:226-242. [PMID: 31789887 DOI: 10.1097/grf.0000000000000503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The pancreas is an organ with both exocrine and endocrine functions that has a vital role in both digestion as well as glucose metabolism. Although pancreatic dysfunction and disorders are rare in pregnancy, they are becoming increasingly more common. Recognition of these disorders and understanding how they can affect pregnancy is imperative to allow for proper management. We provide an overview of the most common pancreatic disorders that are seen in pregnancy.
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22
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P.138 Perioperative management of gestational hypertriglyceridemia-induced acute pancreatitis in a 37-week parturient. Int J Obstet Anesth 2021. [DOI: 10.1016/j.ijoa.2021.103136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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23
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Clinical Course of Chronic Pancreatitis During Pregnancy and its Effect on Maternal and Fetal Outcomes. Am J Gastroenterol 2021; 116:600-608. [PMID: 33657043 DOI: 10.14309/ajg.0000000000001076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/23/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION There are limited data on the effect of chronic pancreatitis (CP) on pregnancy outcomes and vice versa. Our aim was to evaluate the clinical trajectory of CP during pregnancy and its effect on pregnancy outcomes. METHODS All female patients of child-bearing age (≥15 years) diagnosed with CP were studied from January 2004 to July 2019. The change in frequency of painful episodes was assessed before, during, and after pregnancy. Maternal and fetal outcomes were compared between pregnant women (early onset) and women presenting with CP after completion of all pregnancies (late onset). RESULTS Of 187 women with CP, pregnancy outcomes and clinical course were assessed in 99 patients. The frequency of painful exacerbations was significantly lower during pregnancy compared with prepregnancy and postpregnancy periods (P < 0.001). The median pain score decreased significantly to 0 (0-2) during pregnancy from 3 (0-6) before conception and increased to 4 (0-8) after pregnancy (P = 0.002). Women with early onset CP (n = 57) had their first child later and had fewer pregnancies compared with those with late onset CP (n = 42). There was no difference in maternal outcomes such as gestational diabetes, hypertension, and preterm delivery, and fetal outcomes such as abortion, low birth weight, and still birth between the groups. There was no reported congenital anomaly. DISCUSSION Younger patients with CP had later and fewer pregnancies, but there was no increased risk of adverse maternal and fetal outcomes. The clinical course of CP was usually benign during pregnancy with decreased frequency and severity of pain.
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Shi X, Hu Y, Pu N, Zhang G, Zhang J, Zhou J, Ye B, Li G, Ke L, Liu Y, Yang Q, Tong Z, Li W. Risk Factors for Fetal Death and Maternal AP Severity in Acute Pancreatitis in Pregnancy. Front Pediatr 2021; 9:769400. [PMID: 34926347 PMCID: PMC8674812 DOI: 10.3389/fped.2021.769400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/01/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Acute pancreatitis in pregnancy is a rare but highly life-threatening gestational and perinatal disease. Objective: This study aimed to identify the risk factors for fetal death and acute pancreatitis severity. Methods: This retrospective cohort study enrolled patients with acute pancreatitis in pregnancy in our center from January 1, 2012, to August 1, 2020, and classified them according to two clinical endpoints, fetal outcome and disease severity. The groups were examined and compared according to gestational week, etiology, gravidity and parity, complications in pre- and post-delivery, and medical history. Logistic regression analysis was performed to identify the independent risk factors for fetal death and acute pancreatitis severity. Results: Of the 90 enrolled patients, 28 (31.1%) had fetal death and 43 (47.8%) had severe acute pancreatitis. Logistic regression analysis showed that pre-delivery acute respiratory distress syndrome (OR, 5.8; 95% CI, 1.5-22.4; p = 0.010) and gestational week (OR, 0.9; 95% CI, 0.8-1.0; p = 0.011) were risk factors for fetal death. Gestation week (OR, 1.2; 95% CI, 1.1-1.3; p = 0.003) and fetal intrauterine death (OR, 5.9; 95% CI, 1.8-19.4; p = 0.003) were risk factors for severe acute pancreatitis. Conclusions: Pre-delivery acute respiratory distress syndrome and gestational week were independent risk factors for fetal death. Fetal intrauterine death and gestational week were independent risk factors for severe acute pancreatitis.
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Affiliation(s)
- Xiaolei Shi
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yuepeng Hu
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Na Pu
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Guofu Zhang
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jingzhu Zhang
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jing Zhou
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bo Ye
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Gang Li
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Lu Ke
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yuxiu Liu
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Qi Yang
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhihui Tong
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Weiqin Li
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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25
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Preeclampsia and the Risk of Pancreatitis: A Nationwide, Population-Based Cohort Study. Gastroenterol Res Pract 2020; 2020:3261542. [PMID: 33456459 PMCID: PMC7787823 DOI: 10.1155/2020/3261542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 12/08/2020] [Indexed: 12/22/2022] Open
Abstract
Background Preeclampsia is a multiple organ dysfunction during pregnancy, including hepatic, renal, and neurological dysfunction, and is defined as hypertension and proteinuria occurring after 20 weeks of pregnancy. Clinical features seen in preeclampsia are due to relatively poorly perfused placenta and maternal endothelial dysfunction. Some studies have found that preeclampsia may cause acute pancreatitis due to microvascular abnormalities and visceral ischemia. This retrospective cohort study used the Taiwanese National Health Insurance Research Databases (NHIRD) to study the relationship between preeclampsia and the risk of pancreatitis. Methods In total, 606,538 pregnant women were selected from the NHIRD between January 1, 1998 and December 31, 2010. They were divided into a preeclampsia cohort (n = 485,211) and a nonpreeclampsia cohort (n = 121,327). After adjusting for comorbidities that may induce pancreatitis, we analyzed and compared the incidence of pancreatitis in the two cohorts. Results The overall incidence of pancreatitis in the preeclampsia cohort was significantly higher than that in the control cohort (4.29 vs. 2.33 per 10,000 person-years). The adjusted HR of developing pancreatitis increased 1.68-fold (95% CI: 1.19-2.36) in the preeclampsia cohort. In addition, pregnant women with preeclampsia without comorbidities had a significantly high risk of pancreatitis (aHR = 1.83, 95% CI 1.27-2.63). The combined effect of preeclampsia and alcohol-related diseases resulted in the highest risk of pancreatitis (aHR = 43.4, 95% CI: 6.06-311.3). Conclusion Compared with patients without preeclampsia, the risk of pancreatitis in patients with preeclampsia is significantly increased after adjusting for demographics and comorbidities. The risk of pancreatitis is greatly increased when preeclampsia is accompanied by alcohol-related diseases, hepatitis C, gallstones, diabetes, or age of 26–35 years. Early identification and effective control of preeclampsia and the associated comorbidities can reduce the risk of pancreatitis and the associated morbidity and mortality.
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Considering delay of cholecystectomy in the third trimester of pregnancy. Surg Endosc 2020; 35:4673-4680. [PMID: 32875420 DOI: 10.1007/s00464-020-07910-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/17/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Current guidelines support laparoscopic cholecystectomy as the treatment of choice for pregnant women with symptomatic gallbladder disease, regardless of the trimester. Early intervention has remained the standard of care, but recent evidence has challenged this practice in pregnant women. We sought to compare surgical and maternal-fetal outcomes of antepartum versus postpartum cholecystectomy in New York State. METHODS Between 2005 and 2014, the New York Statewide Planning and Research Cooperative System (SPARCS) database was queried for patients who underwent cholecystectomy within 3 months before (antepartum cholecystectomy, APCCY: n = 82) and after (postpartum cholecystectomy, PPCCY: n = 5040) childbirth to approximate third-trimester operations. All patients who underwent cholecystectomy during pregnancy (n = 971) were extracted to evaluate inter-trimester differences. Subgroup analysis compared APCCY patients who were not hospitalized within 1 year before APCCY (n = 80) and PPCCY patients who were hospitalized within 1 year before childbirth (n = 29) for symptomatic biliary disease. Multivariable generalized linear regression models were used to characterize the association between timing of cholecystectomy and several primary outcomes: length of stay (LOS), 30-day non-pregnancy, non-delivery readmission (NPND), bile duct injury (BDI), composite maternal outcome (antepartum hemorrhage, preterm delivery, cesarean section), any complications, and fetal demise. RESULTS Third-trimester APCCY women had longer LOS (Ratio: 1.44, 95% CI [1.26-1.66], p < 0.0001) and greater incidence of preterm delivery (OR 2.54, 95% CI [1.37-4.43], p = 0.0019). Cholecystectomy timing was not independently associated with differences in composite maternal outcome (p = 0.1480), BDI (p = 0.2578), 30-day NPND readmission (p = 0.7579), any complications (p = 0.2506), and fetal demise (2.44% versus 0.44%, p = 0.0545). Subgroup analysis revealed no differences in any of the seven outcomes. CONCLUSIONS New York Statewide data suggest that although laparoscopic cholecystectomy is safe in pregnancy, delay of cholecystectomy should be discussed in the third trimester due to an increased risk for preterm delivery.
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Acar YA, Gunay G, Bilge S, Tezel O. Concomitant hypertriglyceridemia-induced pancreatitis in pregnant monozygotic twin siblings. Gynecol Endocrinol 2020; 36:654-656. [PMID: 32157928 DOI: 10.1080/09513590.2020.1737669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Hypertriglyceridemia-induced pancreatitis (HTIP) is the third most common cause of pancreatitis. Hypertriglyceridemia shows familial transition and pregnancy increases the risk of HTIP. The treatment of HTIP is initiated with supportive treatment and continues with specific treatments including plasmapheresis, insulin, heparin infusion, and hemofiltration. The current study reports monozygotic twins who are pregnant at the same time having concurrent HTIP attack.
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Affiliation(s)
- Yahya Ayhan Acar
- Department of Emergency Medicine, University of Health Sciences, Ankara, Turkey
| | - Gizem Gunay
- Department of Emergency Medicine, University of Health Sciences, Ankara, Turkey
| | - Sedat Bilge
- Department of Emergency Medicine, University of Health Sciences, Ankara, Turkey
| | - Onur Tezel
- Department of Emergency Medicine, University of Health Sciences, Ankara, Turkey
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Nineteen Cases of Severe Acute Pancreatitis in Pregnancy: A 5-Year Single-Center Retrospective Analysis. Pancreas 2020; 49:e54-e55. [PMID: 32590624 DOI: 10.1097/mpa.0000000000001577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Peripartum Severe Acute Pancreatitis with Rare Complications: Case Report and Review of Literature. Case Rep Surg 2020; 2020:5785413. [PMID: 32309004 PMCID: PMC7157796 DOI: 10.1155/2020/5785413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 03/12/2020] [Accepted: 03/23/2020] [Indexed: 12/13/2022] Open
Abstract
Peripartum pancreatitis is a rare clinical condition that occurs usually in the third trimester of pregnancy. Pancreatitis is usually secondary to gallstones, and it can lead to life-threatening and rare complications. We report a case of necrotizing postpartum pancreatitis that developed abdominal compartment syndrome (ACS) in early course, posterior reversible encephalopathy syndrome (PRES), and splanchnic and extrasplanchnic thrombosis later on. Case. 31-year-old female, one week after delivery, presented to the emergency department with abdominal pain, nausea and vomiting, tenderness in the epigastrium, and raised pancreatic enzymes. Ultrasound (USG) showed bulky pancreas with gallstones. She was diagnosed as having acute biliary pancreatitis and started to be hydrated and was supplemented with analgesia. Her condition deteriorated on the 2nd day, and she was shifted to the surgical intensive care unit (SICU) where she developed abdominal compartment syndrome (ACS), respiratory distress, and acute kidney injury, requiring endotracheal intubation and ventilation. Computerized tomography (CT) showed pancreatic necrosis with multiple fluid collections and significant left-sided pleural effusion. Percutaneous drainage of pleural effusion was done, and she was stabilized to be weaned off from mechanical ventilation. On day 15, she underwent USG-guided drainage of the pancreatic collection and ERCP (endoscopic retrograde cholangiopancreatography) on day 19. Post-ERCP, she had tonic colonic convulsions which were treated with benzodiazepines and phenytoin. It was diagnosed by imaging studies as posterior reversible encephalopathy syndrome (PRES). Her abdomen was still distended and tender; CT showed a significant pseudocyst with splanchnic and extrasplanchnic thrombosis. She had laparotomy, gastrocystostomy, and cholecystectomy on day 28th. She made uncomplicated recovery and discharged in good health. Conclusion. Peripartum pancreatitis can be complicated by ACS, PRES, and splanchnic and extrasplanchnic thrombosis.
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Yang Z, Guo G, Li H. Predicting fetal loss in severe acute pancreatitis during pregnancy: a 5-year single-tertiary-center retrospective analysis. Postgrad Med 2020; 132:473-478. [PMID: 32249649 DOI: 10.1080/00325481.2020.1752010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the factors that predict fetal loss in patients with severe acute pancreatitis. METHODS A total of 96,132 cases including 215 patients with acute pancreatitis were evaluated, and 83 cases with severe acute pancreatitis were included in the study. Clinical data and maternal complications were analyzed. RESULTS The incidence of acute pancreatitis during pregnancy was 2.24%, of which 38.6%had severe acute pancreatitis. The maternal mortality and fetal mortality were 3.6% and 32.5%, respectively. Hypertriglyceridemia (HTG) was the most common cause of severe acute pancreatitis during pregnancy and, along with delayed diagnosis, was related to fetal loss. The incidence of maternal complications including multiple organ failure (MOF), gestation diabetes mellitus, and preeclampsia was higher in pregnancies with fetal loss compared with those without fetal loss. In multivariable analysis, the independent predictors associated with fetal loss were gestational age (odds ratio [OR],0.183; 95% confidence interval [CI],0.049-0.677; P = 0.0112), HTG (OR,3.477; 95% CI, 2.152-6.674; P = 0.028), time from onset to diagnosis (OR,2.311; 95% CI,1.958-2.967;P = 0.032), MOF (OR,6.579; 95% CI,2.225-9.873; P = 0.039), gestational diabetes mellitus (OR,5.854; 95% CI,3.043-8.661; P = 0.024), and preeclampsia (OR,6.351; 95% CI,3.667-8.965; P = 0.013). A prediction model incorporating these factors demonstrated an area under the receiver operating characteristic curve of 0.909. CONCLUSION Severe acute pancreatitis during pregnancy leads to a high rate of fetal mortality. Gestational trimester, delayed diagnosis, HTG, MOF, gestational diabetes mellitus, and preeclampsia are predictors of fetal loss. Therefore, close monitoring is essential for pregnancies complicated with HTG, diabetes mellitus, and hypertension.
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Affiliation(s)
- Zhenyu Yang
- Department of Critical Care Medicine, Shengjing Hospital of China Medical University , Shenyang, Liaoning, China
| | - Guangyang Guo
- Department of Gastroenterology, Central Hospital of Benxi , Shenyang, China
| | - Hui Li
- Department of Gastroenterology, Shengjing Hospital of China Medical University , Shenyang, Liaoning, China
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Amir W, Nawaz M, Ahmed Z. A Rare Case of Acute Idiopathic Pancreatitis in Third Trimester Which Aggravated in Early Postpartum Period. Cureus 2020; 12:e7348. [PMID: 32328360 PMCID: PMC7170021 DOI: 10.7759/cureus.7348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acute pancreatitis (AP) in pregnancy and post-partum period is a rare event and can have a lethal effect on the mother and the fetus. Gallstone disease is thought to be the most common causative factor of AP; however, in many cases the cause remains unclear. Here, we present a case of severe AP occurring in late pregnancy which aggravated in the early postpartum period. A 32-year-old multiparous woman, para 7, presented with severe abdominal pain, abdominal distension and multiple episodes of vomiting. The pain was localized to the upper abdomen and radiating to the back, aggravated by food and bending forward. She had neither a history of chronic alcoholism nor any evidence of viral infection was found. The patient was diagnosed with idiopathic severe AP on contrast-enhanced computed tomography, which was managed conservatively and recovered within several days. She did not have any recurrence thereafter and had a good clinical recovery. Therefore, it is important to consider AP when a woman presents with upper abdominal pain, nausea and vomiting in pregnancy and during the postpartum period to improve the maternal outcome for patients with AP.
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Affiliation(s)
- Washma Amir
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Marrium Nawaz
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Zohaib Ahmed
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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The Hepatobiliary System: An Overview of Normal Function and Diagnostic Testing in Pregnancy. Clin Obstet Gynecol 2019; 63:122-133. [PMID: 31770121 DOI: 10.1097/grf.0000000000000504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Pregnancy is associated with physiological adaptions that affect every organ system. Changes in liver function in pregnancy have important effects on nutrient metabolism, protein synthesis, and the biotransformation of substances in preparation for excretion. A clear understanding of the anatomic and functional changes of the hepatobiliary system is necessary for the diagnosis and evaluation of disease, as well as understanding how these changes predispose women to pregnancy-specific hepatic conditions. In this review, the effect of gestational changes in hepatobiliary function on laboratory tests and the role of diagnostic imaging of the liver and gallbladder in pregnancy will be discussed.
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Challenges encountered in the management of gall stones induced pancreatitis in pregnancy. Int J Surg 2019; 71:72-78. [DOI: 10.1016/j.ijsu.2019.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/10/2019] [Accepted: 09/16/2019] [Indexed: 12/27/2022]
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Ong M, Jerreat L, Hameed A. Familial hypertriglyceridaemia and type 2 diabetes in pregnancy: prevention of acute pancreatitis with diet control and omega-3 fatty acids. BMJ Case Rep 2019; 12:12/5/e227321. [PMID: 31110063 DOI: 10.1136/bcr-2018-227321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Acute pancreatitis in pregnancy is rare and can be caused by hypertriglyceridaemia. The management of hypertriglyceridaemia in pregnancy is complex and challenging as many lipid-lowering medications have been found to be unsafe in pregnancy. Patients who present with hypertriglyceridaemia commonly have multiple risk factors such as, diabetes, alcohol excess and hypothyroidism which pose a greater challenge to the management of these patients. We present a case of a 31-year-old woman presenting with familial hypertriglyceridaemia and type 2 diabetes mellitus in her third pregnancy. She had an uneventful pregnancy with the use of omega-3 fatty acids nutritional support, low-fat diet and tight glucose control with insulin and metformin.
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Affiliation(s)
- Melissa Ong
- Faculty of Life Sciences and Medicine, King's College London School of Medical Education, London, UK
| | - Lynne Jerreat
- Department of Obstetrics and Gynaecology, Princess Royal University Hospital, Orpington, UK
| | - Aisha Hameed
- Department of Obstetrics and Gynaecology, Princess Royal University Hospital, Orpington, UK
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Kandemir A, Coşkun A. Treatment of hypertriglyceridemia-induced acute pancreatitis with therapeutic plasma exchange in 2 pregnant patients. J OBSTET GYNAECOL 2019; 39:702-704. [PMID: 30917728 DOI: 10.1080/01443615.2018.1553939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Altay Kandemir
- a Department of Gastroenterology, School of Medicine , Adnan Menderes University , Aydin , Turkey
| | - Adil Coşkun
- a Department of Gastroenterology, School of Medicine , Adnan Menderes University , Aydin , Turkey
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Littlefield A, Lenahan C. Cholelithiasis: Presentation and Management. J Midwifery Womens Health 2019; 64:289-297. [PMID: 30908805 DOI: 10.1111/jmwh.12959] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 12/24/2022]
Abstract
Cholelithiasis affects approximately 15% of the US population. Rising trends in obesity and metabolic syndrome have contributed to an increase in diagnosis of cholelithiasis. There are several risk factors for cholelithiasis, both modifiable and nonmodifiable. Women are more likely to experience cholelithiasis than are men. Pregnancy, increasing parity, and obesity during pregnancy further increase the risk that a woman will develop cholelithiasis. The classic presentation of persons experiencing cholelithiasis, specifically when gallstones obstruct the common bile duct, is right upper quadrant pain of the abdomen that is often elicited upon palpation during physical examination and documented as a positive Murphy's sign. Referred pain to the right supraclavicular region and/or shoulder, nausea, and vomiting are also frequently reported by persons with cholelithiasis. Cholelithiasis can result in complications, including cholecystitis (inflammation of the gallbladder) and cholangitis (inflammation of the bile duct). Lack of physical examination findings does not rule out a diagnosis of cholelithiasis. Laboratory tests such as white blood cell count, liver enzymes, amylase, and lipase may assist the clinician in diagnosing cholelithiasis; however, ultrasonography is the gold standard for diagnosis. Management is dependent on severity and frequency of symptoms. Lifestyle and dietary modifications combined with medication management, such as use of gallstone dissolution agents, may be recommended for persons who have a single symptomatic episode. If symptoms become severe and/or are recurrent, laparoscopic cholecystectomy is recommended. It is recommended that individuals with an established diagnosis of cholelithiasis be referred to a surgeon and/or gastroenterologist within 2 weeks of initial presentation regardless of severity or frequency of symptoms.
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Nasioudis D, Doulaveris G, Kanninen TT. Dyslipidemia in pregnancy and maternal-fetal outcome. ACTA ACUST UNITED AC 2018; 71:155-162. [PMID: 30318877 DOI: 10.23736/s0026-4784.18.04330-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Hyperlipidemia is a known cause of atherosclerosis and directly contributes to the current epidemic in cardio-vascular disease. Pregnancy is typified by an increase in serum levels of total cholesterol and triglycerides pushed by the rise in estrogen, progesterone and lactogen. Mobilization of stored fat depots in late pregnancy may provide a reservoir of fatty acids for fetal growth and placental tissue steroid synthesis. This physiologic increase in lipids performs an essential role during pregnancy; however, elevated levels of lipids in predisposed women or with familiar forms of hyperlipidemia can carry increased risk for maternal-fetal complications. The present treatment of pregnant women with hyperlipidemia is the suspension of medications. However, hyperlipidemia during pregnancy is associated with preeclampsia, preterm birth and gestational diabetes and offspring of these mothers show a propensity to enhanced fatty streak formation and an increased risk of progressive atherosclerosis. This current evidence may motivate the further study on the potential benefits of treatment of hyperlipidemia in pregnancy and its effects on maternal-fetal outcomes.
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Affiliation(s)
- Dimitrios Nasioudis
- Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Georgios Doulaveris
- Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, New York, NY, USA
| | - Tomi T Kanninen
- Department of Obstetrics and Gynecology, Richmond University Medical Center, New York, NY, USA -
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Cao S, Dao N, Roloff K, Valenzuela GJ. Pregnancies Complicated by Familial Hypertriglyceridemia: A Case Report. AJP Rep 2018; 8:e362-e364. [PMID: 30591842 PMCID: PMC6306273 DOI: 10.1055/s-0038-1676832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 11/14/2018] [Indexed: 11/26/2022] Open
Abstract
Background Although rare, familial hypertriglyceridemia can cause acute and life-threatening complications in pregnancy. Cases The first patient's pregnancy was complicated by multiple admissions for pancreatitis due to hypertriglyceridemia and noncompliance with gemfibrozil. In her second pregnancy, she was compliant with gemfibrozil and only experienced pancreatitis episodes toward the end of pregnancy. The second patient had diabetes mellitus and familial hypertriglyceridemia. She required multiple hospitalizations for diabetic ketoacidosis secondary to insulin noncompliance. In both pregnancies, she was compliant with gemfibrozil and had no complications related to hypertriglyceridemia. Conclusion Treatment with gemfibrozil in pregnancies complicated by hypertriglyceridemia may prevent complications without adverse maternal or fetal effects and could be considered in treating pregnant patients with severe hypertriglyceridemia. These cases also demonstrate the importance of medication compliance in the prevention of poor outcomes.
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Affiliation(s)
- Suzanne Cao
- Department of Women's Health, Arrowhead Regional Medical Center, Colton, California
| | - NhuChi Dao
- Department of Women's Health, Arrowhead Regional Medical Center, Colton, California
| | - Kristina Roloff
- Department of Women's Health, Arrowhead Regional Medical Center, Colton, California
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Yalcin Bahat P, Turan G, Aslan Cetin B. Abruptio Placentae Caused by Hypertriglyceridemia-Induced Acute Pancreatitis during Pregnancy: Case Report and Literature Review. Case Rep Obstet Gynecol 2018; 2018:3869695. [PMID: 30254776 PMCID: PMC6145316 DOI: 10.1155/2018/3869695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 08/16/2018] [Accepted: 08/27/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hormonal effects during pregnancy can compromise otherwise controlled lipid levels in women with hypertriglyceridemia and predispose to pancreatitis leading to increased morbidity for mother and fetus. Elevation of triglyceride levels is a risk factor for development of pancreatitis if it exceeds 1000 mg/dL. Pancreatitis should be considered in emergency cases of abdominal pain and uterine contractions in Emergency Department at any stage of pregnancy. We report a case of abruptio placentae caused by hypertriglyceridemia-induced acute pancreatitis. Also, literature review of cases of acute pancreatitis induced by hypertriglycaemia in pregnancy has been made. CASE A 22-year-old woman presented to our Emergency Department, at 35 weeks of gestation, for acute onset of abdominal pain and uterine contractions. Blood tests showed a high rate of triglyceride. The patient was diagnosed with abruptio placentae caused by hypertriglyceridemia-induced acute pancreatitis. Immediate cesarean section was performed and it was observed that blood sample revealed a milky turbid serum. Insulin, heparin, and supportive treatment were started. She was discharged on the 10th day. CONCLUSION Consequently, patients with known hypertriglyceridemia or family history should be followed up more closely because any delay can cause disastrous conclusions for mother and fetus. Acute pancreatitis should be considered in pregnant women who have sudden onset, severe, persistent epigastric pain and who have a risk factor for acute pancreatitis.
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Affiliation(s)
- Pınar Yalcin Bahat
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul Health Sciences University, Istanbul, Turkey
| | - Gokce Turan
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul Health Sciences University, Istanbul, Turkey
| | - Berna Aslan Cetin
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul Health Sciences University, Istanbul, Turkey
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Cumulative Financial Burden of Readmissions for Biliary Pancreatitis in Pregnant Women. Obstet Gynecol 2018; 132:415-422. [DOI: 10.1097/aog.0000000000002740] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Management of Gallstone-Induced Acute Pancreatitis in Pregnancy: A Tertiary-Center Experience. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2018; 52:92-96. [PMID: 32595379 PMCID: PMC7315056 DOI: 10.14744/semb.2017.60490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/23/2017] [Indexed: 11/26/2022]
Abstract
Objectives: Gallbladder stones are the most frequently reported etiology of acute pancreatitis in pregnancy and are often diagnosed in the third trimester. This condition is associated with both mother and infant morbidity and mortality, and its treatment remains controversial. Methods: Relevant patient data between September 2010 and April 2017 from the Kanuni Sultan Suleyman Training and Research Hospital were analyzed regarding etiology (of gallstone pancreatitis), trimester of pregnancy, diagnostic tools, pancreatitis stage, clinical status, medical treatment, surgical interventions, and pregnancy status. Results: We included 68 patients recorded with acute pancreatitis due to biliary gallstones. Pancreatitis symptoms developed in most (n=38) (55.8%) patients during the third trimester. Of 24 patients who had their first episode of pancreatitis in the first trimester of pregnancy, 12 (50%) were readmitted due to recurrence. Seven (11.3%) patients whose Ranson scale score was 3 underwent computed tomography evaluation. The number of patients with acute cholecystitis with pancreatitis was 5 (7.3%), whereas the number of patients with choledocholithiasis was 4 (5.8%). Sphincterotomy with endoscopic retrograde cholangiopancreatography was performed in 2 (2.9%) patients. Laparoscopic cholecystectomy was performed in 9 (13.2%) patients during pregnancy. No fetal and maternal morbidity and mortality was found in all periods. Conclusion: Developments in supportive care, wide-spread use of imaging methods, and a multidisciplinary approach with better antenatal care of pregnant patients with acute pancreatitis can help prevent fetal and maternal morbidity and mortality in such cases. Early laparoscopic cholecystectomy should be considered especially in pregnant patients with acute pancreatitis due to gallstones in the first trimester.
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Tang M, Xu JM, Song SS, Mei Q, Zhang LJ. What may cause fetus loss from acute pancreatitis in pregnancy: Analysis of 54 cases. Medicine (Baltimore) 2018; 97:e9755. [PMID: 29443736 PMCID: PMC5839860 DOI: 10.1097/md.0000000000009755] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Acute pancreatitis in pregnancy (APIP) poses a serious threat to the mother and her fetus, and might lead to fetal loss including miscarriage and stillbirth in certain patients. We sought to identify possible factors that affect fetal distress and evaluated outcomes of patients with APIP.We retrospectively reviewed clinical records of 54 pregnant women with APIP, who were treated at 2 tertiary clinical centers over a 6-year period. Clinical characteristics including etiology and severity of APIP, fetal monitoring data, and maternofetal outcomes were analyzed.Etiology of APIP included acute biliary pancreatitis (ABP, n = 14), hyperlipidemic pancreatitis (HLP, n = 22), and other etiologies (n = 18). Severity was classified as mild acute pancreatitis (MAP, n = 23), moderately severe acute pancreatitis (MSAP, n = 24), and severe acute pancreatitis (SAP, n = 7). The incidence of preterm delivery, fetal distress, and fetal loss increased with the progression of severity of APIP (P < .05). The severity of HLP was significantly higher than that of ABP and APIP of other etiology (P < .01). HLP was more likely to lead to fetal distress than other APs (P < .01). Only 12 (22.2%) patients had fetal monitoring including non-stress test (NST); 1 case of SAP (14.3%) and 15 cases of MSAP (62.5%) were not transferred to intensive care unit for intensive monitoring.The incidence of fetal distress and fetal loss increased with worsening of APIP severity. HLP tends to result in worse fetal outcomes. The deficiencies of fetal state monitoring, lack of assessment, and management of pregnant women might increase the fetal loss in APIP.
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Affiliation(s)
- Min Tang
- Department of Gastroenterology, the First Hospital of Anhui Medical University
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, China
| | - Jian-Ming Xu
- Department of Gastroenterology, the First Hospital of Anhui Medical University
| | - Sha-Sha Song
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, China
| | - Qiao Mei
- Department of Gastroenterology, the First Hospital of Anhui Medical University
| | - Li-Jiu Zhang
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, China
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Trezevant MS, Winton JC, Holmes AK. Hypercalcemia-Induced Pancreatitis in Pregnancy Following Calcium Carbonate Ingestion. J Pharm Pract 2017; 32:225-227. [PMID: 29241388 DOI: 10.1177/0897190017745410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Calcium carbonate is often used to relieve Gastroesophageal Reflux Disease (GERD) in pregnant patients. This report describes a potentially serious complication. CASE A pregnant female presented at 34 weeks gestation with abdominal pain, nausea, and vomiting. Home medications included an unquantifiable amount of calcium carbonate 500 mg due to constant consumption for GERD. Laboratory findings included elevated calcium, amylase, lipase, and triglyceride level. Pancreatitis was diagnosed and abdominal ultrasound excluded gallstones. Despite hydration, lipase rose and emergency cesarean section was performed. Hypercalcemia was managed by intravenous fluid administration. After delivery, pancreatitis resolved. CONCLUSION Pancreatitis developed in pregnant patient with hypercalcemia due to excessive calcium carbonate ingestion and resolved after delivery of the fetus, fluid resuscitation, and return of calcium level to normal.
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Affiliation(s)
- May S Trezevant
- 1 Pharmacy Department, Methodist Le Bonheur Healthcare, Germantown, TN, USA
- 2 Department of Pharmacy Practice, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - John C Winton
- 3 Greenville Health System - Hospitalist Division, Greenville Memorial Hospital, Greenville, SC, USA
| | - Ashley K Holmes
- 4 Pharmacy Department, Saint Luke's Hospital, Kansas City, MO, USA
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Guo ZD, Zhao L, Wang P, Deng WH, Shi Q, Zuo T, Hong YP, Wang WX. Fetal liver injury ameliorated by migration inhibitory factor inhibition in a rat model of acute pancreatitis in pregnancy. J Obstet Gynaecol Res 2017; 44:374-383. [PMID: 29227009 DOI: 10.1111/jog.13538] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 09/28/2017] [Indexed: 12/11/2022]
Abstract
AIM This study was designed to investigate and assess fetal liver injury in a rat model of acute pancreatitis in pregnancy (APIP) as well as its possible mechanisms and potential therapeutic targets. METHODS The APIP model was induced by sodium taurocholate in Sprague-Dawley rats during the third trimester. ISO-1, a macrophage migration inhibitory factor (MIF) antagonist, was given before the induction of APIP. In addition, sham-operated rats at later gestation were set as controls. Histological changes in the fetal liver and maternal pancreas were assessed. Amylase and lipase activity as well as the levels of tumor necrosis factor (TNF)-α and interleukin (IL)-1β were examined. The expression of MIF in fetal liver was determined by immunochemistry and the expression of NF-κB, IκBα, high mobility group box-1 protein (HMGB1), TNF-α, and IL-1β in fetal liver was determined by Western blot analysis. Ultrastructures of hepatic cells in fetal rats were observed under transmission electron microscopy. RESULTS ISO-1 ameliorated the following: (i) pathological injuries in maternal pancreas and fetal liver; (ii) levels of TNF-α and IL-1β in maternal serum; and (iii) levels of MIF, myeloperoxidase, NF-κB, HMGB1, TNF-α, and IL-1β in fetal liver. CONCLUSION Pathological damage and an inflammatory response in fetal liver were induced by APIP, and MIF inhibition ameliorated fetal liver injury by inhibiting the inflammatory cascade.
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Affiliation(s)
- Zheng-Da Guo
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Liang Zhao
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, China.,Key Laboratory of Hubei Province for Digestive System Disease, Wuhan, China
| | - Peng Wang
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wen-Hong Deng
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qiao Shi
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Teng Zuo
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yu-Pu Hong
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, China.,Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wei-Xing Wang
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, China
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Clinical characteristics of acute pancreatitis in pregnancy: experience based on 121 cases. Arch Gynecol Obstet 2017; 297:333-339. [PMID: 29164335 PMCID: PMC5778161 DOI: 10.1007/s00404-017-4558-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/28/2017] [Indexed: 12/13/2022]
Abstract
Purpose Acute pancreatitis in pregnancy (APIP) is a rare condition; however, it markedly affects maternal and fetal health. This study aimed to describe the types, clinical characteristics, mortality, and the safety and necessity of gestation termination of acute pancreatitis in pregnancy (APIP). Methods We retrospectively reviewed 121 APIP cases in the Gastroenterology Department of The First Affiliated Hospital of Nanchang University. APIP diagnosis were based on 2012 Atlanta Criteria. The correlation between APIP types, severity, biochemical parameters and mortality was analyzed. Results The most common symptoms for APIP were abdominal pain (86.8%) and vomiting (73.6%). The most common causes for APIP were gallstone (36.4%) and hypertriglyceridemia (32.2%) and hypertriglyceridemic APIP was correlated with a higher rate for local complication (P = 0.012). Serum calcium level was negatively correlated with the severity of APIP (P < 0.01). The overall maternal and fetal mortality rate were 3.3% (4/121) and 11.6% (14/121), respectively. The severity of APIP was significantly correlated with higher risks for maternal and fetal death (P < 0.01). 72.7% of moderate-to-severe APIP patients underwent Cesarean section to terminate gestation safely. Conclusion The most common causes of APIP were gallstone and hypertriglyceridemia. Lower level of serum calcium could be used as an indicator for the severity of the APIP. The severity of APIP was associated with higher risk for neonate asphyxia, and maternal and fetal death.
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46
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Skubic JJ, Salim A. Emergency general surgery in pregnancy. Trauma Surg Acute Care Open 2017; 2:e000125. [PMID: 29766116 PMCID: PMC5887777 DOI: 10.1136/tsaco-2017-000125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/20/2017] [Accepted: 08/28/2017] [Indexed: 01/07/2023] Open
Abstract
It is often that the acute care surgeon will be called on to evaluate the pregnant patient with abdominal pain. Most of the diagnostic and management decisions regarding pregnant patients will follow the usual tenets of surgery; however, there are important differences in the pregnant patient to be aware of to avoid pitfalls which can lead to complications for both mother and fetus. This review hopes to describe the most common emergencies facing the surgeon caring for the pregnant patient and the latest management options.
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Affiliation(s)
- Jeffrey J Skubic
- Division of Trauma, Burn and Surgical Critical Care, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ali Salim
- Division of Trauma, Burn and Surgical Critical Care, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Ibiebele I, Schnitzler M, Nippita T, Ford JB. Outcomes of Gallstone Disease during Pregnancy: a Population-based Data Linkage Study. Paediatr Perinat Epidemiol 2017; 31:522-530. [PMID: 28881393 DOI: 10.1111/ppe.12406] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Gallstone disease is a leading indication for non-obstetric abdominal surgery during pregnancy. There are limited whole population data on maternal and neonatal outcomes. This population-based study aims to describe the outcomes of gallstone disease during pregnancy in an Australian setting. METHODS Linked hospital, birth, and mortality data for all women with singleton pregnancies in New South Wales, Australia, 2001-2012 were analysed. Exposure of interest was gallstone disease (acute biliary pancreatitis, gallstones with/without cholecystitis). Outcomes including preterm birth (spontaneous and planned), readmission, morbidity and mortality (maternal and neonatal) were compared between pregnancies with and without gallstone disease. Adjusted risk ratios (aRRs) and 99% confidence intervals were estimated using modified Poisson regression and adjusted for maternal and pregnancy factors. RESULTS Among 1 064 089 pregnancies, 1882 (0.18%) had gallstone disease. Of these, 239 (12.7%) had an antepartum cholecystectomy and 1643 (87.3%) were managed conservatively. Of those managed conservatively, 319 (19.0%) had a postpartum cholecystectomy. Gallstone disease was associated with increased risk of preterm birth (aRR 1.3, 99% CI 1.1, 1.6), particularly planned preterm birth (aRR 1.6, 99% CI 1.2, 2.1), maternal morbidity (aRR 1.6, 99% CI 1.1, 2.3), maternal readmission (aRR 4.7, 99% CI 4.2, 5.3), and neonatal morbidity (aRR 1.4, 99% CI 1.1, 1.7). Surgery was associated with decreased risk of maternal readmission (aRR 0.4, 99% CI 0.2, 0.7). CONCLUSIONS Gallstone disease during pregnancy was associated with adverse maternal and neonatal outcomes. Most women with gallstone disease during pregnancy are managed conservatively. Surgical management was associated with decreased risk of readmission.
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Affiliation(s)
- Ibinabo Ibiebele
- Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, Sydney, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia
| | - Margaret Schnitzler
- Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,Department of Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Tanya Nippita
- Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, Sydney, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,Department of Obstetrics and Gynaecology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Jane B Ford
- Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, Sydney, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia
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Chibber T, Gibson PS. Fatal Abdominal Compartment Syndrome Due to Severe Triglyceride-Induced Pancreatitis in Early Pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:609-613. [PMID: 28986186 DOI: 10.1016/j.jogc.2017.06.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 06/20/2017] [Accepted: 06/21/2017] [Indexed: 01/27/2023]
Abstract
Serum levels of maternal lipids rise physiologically in normal pregnancy, and women with underlying hypertriglyceridemia may experience dramatic elevations which place them at risk for pancreatitis. We describe the case of a woman with severe familial hypertriglyceridemia and prior pancreatitis who discontinued her lipid-lowering therapy early in pregnancy. She promptly developed severe abdominal pain and was hospitalized with acute pancreatitis during the late first trimester. Despite aggressive medical treatment and critical care monitoring, she developed abdominal compartment syndrome (ACS) with associated acute renal failure, which progressed to cardiorespiratory failure and was ultimately fatal. ACS is an alarming complication of acute pancreatitis that has been poorly studied in pregnancy.
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Affiliation(s)
| | - Paul S Gibson
- Departments of Medicine and Obstetrics & Gynecology, University of Calgary, Calgary, AB.
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Zhao L, Zuo T, Shi Q, Mei FC, Hong YP, Deng WH, Yu J, Hu P, Wang WX. A preliminary study on fetal lung injury in a rat model of acute pancreatitis in pregnancy. Pathol Res Pract 2017; 213:1370-1377. [PMID: 29033186 DOI: 10.1016/j.prp.2017.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 09/03/2017] [Accepted: 09/15/2017] [Indexed: 12/23/2022]
Abstract
Acute pancreatitis in pregnancy (APIP), which was thought to be rare, is becoming more frequent. In addition, high perinatal mortality among fetuses has been reported. Our research aimed to investigate and assess fetal lung injury in a rat model of APIP and its possible mechanisms. The APIP model was induced by sodium taurocholate in Sprague-Dawley rats during the third trimester. Sham-operated (SO) rats in late gestation were used as controls, and dynamic observation and detection in the SO and acute pancreatitis (AP) groups were performed at 3 time-points. Histological changes in the fetal lungs, as well as the maternal pancreas and placenta were assessed. The levels of serum amylase, lipase, TNF-α and IL-1β were detected in maternal rats, and the expression of surfactant proteins A, B, C and D as well as their mRNA were determined. In this study, fetal lung injury as well as maternal pancreas and placenta injuries occurred in a time-dependent manner. The levels of serum amylase, lipase and TNF-α were markedly increased in maternal rats, and the levels of surfactant proteins A, B, C and D in fetal lungs were significantly decreased in the fetal lungs of the AP group. Ultrastructure injuries and the dysregulated synthesis and secretion of pulmonary surfactant proteins were observed in the AP group. Our research suggests that fetal lung injury is involved in the rat model of APIP and that the dysregulated synthesis and secretion of pulmonary surfactant proteins play a critical role in fetal lung injury during APIP.
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Affiliation(s)
- Liang Zhao
- Department of General Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, Hubei Province 430060, China; Key laboratory of Hubei Province for Digestive System Disease, 9 Zhangzhidong Road, Wuhan, Hubei Province 430060, China
| | - Teng Zuo
- Department of General Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, Hubei Province 430060, China
| | - Qiao Shi
- Department of General Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, Hubei Province 430060, China
| | - Fang-Chao Mei
- Department of General Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, Hubei Province 430060, China; Central Laboratory, Renmin Hospital of Wuhan University, 9 Zhangzhidong Road, Wuhan, Hubei Province 430060, China
| | - Yu-Pu Hong
- Department of General Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, Hubei Province 430060, China
| | - Wen-Hong Deng
- Department of General Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, Hubei Province 430060, China
| | - Jia Yu
- Department of General Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, Hubei Province 430060, China
| | - Peng Hu
- Department of General Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, Hubei Province 430060, China; Central Laboratory, Renmin Hospital of Wuhan University, 9 Zhangzhidong Road, Wuhan, Hubei Province 430060, China
| | - Wei-Xing Wang
- Department of General Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, Hubei Province 430060, China.
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Rupprecht H, Reinfelder J, Turkoglu A. A case of severe acute necrotizing pancreatitis in a 38-year-old woman postpartum due to a parathyroid adenoma. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2017; 6:Doc13. [PMID: 28868227 PMCID: PMC5566115 DOI: 10.3205/iprs000115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Lethal necrotizing pancreatitis postpartum due to primary hyperparathyroidism caused by a parathyroid adenoma can be considered as a rarity. Due to the unspecific clinical signs and uncommonness this disorder may be overseen very easily. The reported case illustrates the very importance of early diagnosis of this endocrine disorder in pregnancy in order to avoid a lethal course.
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Affiliation(s)
- Holger Rupprecht
- Department of Visceral, Thoracic, and Vascular Surgery, Surgical Clinic Fürth, Germany
| | - Julia Reinfelder
- Department of Visceral, Thoracic, and Vascular Surgery, Surgical Clinic Fürth, Germany
| | - Alp Turkoglu
- Department of Visceral, Thoracic, and Vascular Surgery, Surgical Clinic Fürth, Germany
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