Management of hypertriglyceridaemia-induced acute pancreatitis in pregnancy. (May 2015)

• Record Type: Journal Article
• Authors: Amin, Tejal; Poon, Leona C. Y.; Teoh, T. G.; Moorthy, K.; Robinson, Stephen; Neary, Nicola; Valabhji, Jonathan
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 28:Number 8(2015)
• Page Start: 954
• Page End: 958
• Publication Date: 2015-05
• Subjects: Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• DOI: 10.3109/14767058.2014.939064
• Languages: English
• ISSNs: 1476-7058

Abstract

<abstract> <title>Abstract</title> <p> <italic>Introduction</italic>: Acute pancreatitis is a recognised rare complication in pregnancy. The reported incidence varies between 3 and 7 in 10 000 pregnancies and is higher in the third trimester. The commonest causes in pregnancy include gallstones, alcohol and hypertriglyceridaemia. Non-gallstone pancreatitis is associated with more complications and poorer outcome with hypertriglyceridaemia-induced acute pancreatitis having mortality rates ranging from 7.5 to 9.0% and 10.0 to 17.5% for mother and foetus, respectively.</p> <p> <italic>Case history</italic>: A 40-year-old para 4 woman, who presented at 15<sup>+4</sup> weeks' gestation, was diagnosed with acute pancreatitis. Past medical history included Graves' disease and hypertriglyceridaemia. Fenofibrate was discontinued immediately after discovery of the pregnancy. Initial investigations showed elevated amylase (475.0 µ/L) and triglycerides (46.6 mmol/L). Imaging revealed an inflamed pancreas without evidence of biliary obstruction/gallstones hence confirming the diagnosis of hypertriglyceridaemia-induced acute pancreatitis. Laboratory tests gradually improved (triglyceride 5.2 mmol/L on day 17). On day 18, ultrasound confirmed foetal demise (18<sup>+1</sup> weeks) and a hysterotomy was performed as she had had four previous caesarean sections.</p> <p> <italic>Conclusion</italic>: Management of acute pancreatitis in pregnancy requires a multi-disciplinary approach. Hypertriglyceridaemia-induced acute pancreatitis has poor outcomes when diagnosed in early pregnancy. Identifying those at risk pre-pregnancy and antenatally can allow close monitoring through pregnancy to optimise care.</p> </abstract>