Management of pancreatitis complicating pregnancy

Pregnancy complicated by pancreatitis may lead to significant fetal and maternal morbidity and mortality. We reviewed the clinical course of 30 women who developed pancreatitis in our institution during pregnancy from 1988 to 1992. Pancreatitis complicated 0.07 per cent of pregnancies (n = 46,075) during this time period. The etiology was gallstones in 22 patients, alcohol in 2 patients, and idiopathic in 6 patients. Average age, multiparity, and symptoms at presentation were similar between patients with gallstone (GSP) or non-gallstone pancreatitis (NGSP). All patients were initially treated medically. GSP patients had significantly lower Ranson criteria than NGSP (0.7 vs. 1.9, P < 0.01), but response to initial therapy, need for emergency surgery, fetal outcome, and fetal and maternal mortality (0 per cent) were the same. Twenty-six of 30 patients were successfully treated with conservative management. A significantly higher relapse rate was seen in GSP than NGSP patients before delivery (72% vs. 0%, P < 0.05). These relapses required hospitalization 90 per cent of the time and resulted in 3.9 additional days per patient. Six patients underwent surgery during pregnancy (two in the first trimester and four in the second trimester) without fetal or maternal mortality and with normal birthweights and Apgar scores. No relapses or additional days in hospital were noted in GSP patients following surgery. We recommend that GSP patients presenting in the first or second trimester should, if possible, undergo cholecystectomy in the second trimester when the risk of anesthesia and premature labor are the lowest. Patients presenting in the third trimester should undergo surgery immediately post-partum. These guidelines should minimize fetal and maternal morbidity from GSP while reducing the number of relapses and additional days in hospital.