MANAGEMENT OF PANCREATITIS COMPLICATING PREGNANCY

Pregnancy complicated by pancreatitis may lead to significant fetal an d maternal morbidity and mortality. We reviewed the clinical course of 30 women who developed pancreatitis in our institution during pregnan cy from 1988 to 1992. Pancreatitis complicated 0.07 per cent of pregna ncies (n = 46,075) during this time period. The etiology was gallstone s in 22 patients, alcohol in 2 patients, and idiopathic in 6 patients. Average age, multiparity, and symptoms at presentation were similar b etween patients with gallstone (GSP) or non-gallstone pancreatitis (NG SP). All patients were initially treated medically. GSP patients had s ignificantly lower Ranson criteria than NGSP (0.7 vs. 1.9, P < 0.01), but response to initial therapy, need for emergency surgery, fetal out come, and fetal and maternal mortality (0 per cent) were the same. Twe nty-six of 30 patients were successfully treated with conservative man agement. A significantly higher relapse rate was seen in GSP than NGSP patients before delivery (72% vs. 0%, P < 0.05). These relapses requi red hospitalization 90 per cent of the time and resulted in 3.9 additi onal 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 sc ores. No relapses or additional days in hospital were noted in GSP pat ients following surgery. We recommend that GSP patients presenting in the first or second trimester should, if possible, undergo cholecystec tomy in the second trimester when the risk of anesthesia and premature labor are the lowest. Patients presenting in the third trimester shou ld undergo surgery immediately post-partum. These guidelines should mi nimize fetal and maternal morbidity from GSLP while reducing the numbe r of relapses and additional days in hospital.