Table 1 Acute pancreatitis and HTG induced acute pancreatitis features in pregnant versus non-pregnant patients
Pregnant patient | NON-pregnant patient | |
|---|---|---|
Acute pancreatitis | ||
Incidence | 1/1000–10000 [3] | 10–44/100000 [54] |
Etiology | Gallstones 65% Alcohol 5–10% HTG (up to 14.4%) [9] | Gallstones (40–70%) Alcohol (25–35%) HTG (2–4%) [55] |
HTG - Acute pancreatitis | ||
Pathogenesis | Primary (genetic) & Secondary (acquired) disorders of lipoprotein metabolism + Increased lipogenesis & Diminished lipolysis of pregnancy | Primary (genetic) & Secondary (acquired) disorders of lipoprotein metabolism |
Clinical predictors | - Unhealthy diet - Metabolic syndrome - Excessive weight gain in pregnancy. | - Unhealthy diet - Metabolic syndrome |
Mortality | - Maternal (37%), fetal (60%) [56] - 0% maternal and fetal loss rate reported recently but figures are poorer in low income settings | |
Clinical presentation HTG-AP | - multiparous (75%) [59] - 3rd trimester of pregnancy (50%), early postpartum (38%) - may be complicated by the onset of labor, obstetrical emergencies (placental abruption, eclampsia, HELLP syndrome, uterine rupture) | - generally younger than patients, with other etiologies; - higher chance of systemic inflammatory response syndrome and cardiopulmonary and renal insufficiency; |
Management guidelines | There are no specific pregnancy related mentions in international guidelinesa | - 2019 World Society of Emergency Surgery guidelines for the management of severe acute pancreatitis [57] - 2018 Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis [60] |
Severity | HTG is an independent indicator of poor prognosis in AP. Elevated serum TG independently and proportionally correlate with persistent organ failure in AP patients, regardless of etiology [61]. | |
Prophylactic measures | Lifestyle adjustments Niacin, omega-3 fatty acids Discontinue fibrates/statins Currently there are no guidelines for the management of thepregnant patient at risk for HTG-AP | Lifestyle adjustments Niacin/Fibrates/ Statins |
Initial management | Fasting, bowel rest Analgesics Hydration & electrolite imbalace correction Measures delayed if diagnostic uncertainty | Fasting, bowel rest Analgesics Hydration & electrolite imbalace correction |
Lipid lowering therapies | Niacin, omega-3 fatty acids Insulin/heparin infusion Plasmapheresis | Antilipemics Insulin/heparin infusion Plasmapheresis |
Obstetric decison making | Emergency termination of pregnancy Vaginal delivery preferable | None |