Background The acute abdomen remains a challenge for all obstetricians and physicians who take part in the care of women in pregnancy. To add substantially to our understanding of acute pancreatitis （AP） in pregnanc...Background The acute abdomen remains a challenge for all obstetricians and physicians who take part in the care of women in pregnancy. To add substantially to our understanding of acute pancreatitis （AP） in pregnancy, in particular affirming the increased risks for mother and fetus associated with AP, we explored features of clinical manifestation and the strategy of management of this disease during pregnancy, and its effects on maternal and fetal outcomes. Methods A retrospective review of medical records of all pregnant patients diagnosed with AP admitted to the Department of Obstetrics and Gynecology, Sixth People＇s Hospital Affiliated to Shanghai Jiao Tong University between 2005 and 2010 was performed. Information was collected from presentation, management, and outcome from medical records. Results There were 11 cases in 2010, accounting for 44% of 25 cases. Among these cases, mild AP （MAP） occurred in 15 cases （60%）, while the rest cases were severe AP （SAP） （40%）. The major etiology of AP in pregnancy was due to gallstone and cholecystitis. Clinical features together with elevation of the plasma concentrations of pancreatic enzymes were the cornerstones of diagnosis. Positive conservative treatment was taken in most of the cases （21 cases, 84%） with a favorable outcome. Seven cases of critically ill patients were monitored in intensive care unit, and 4 patients underwent surgical interventions. As a result, all of 25 patients had better prognosis, no maternal death was observed. There were 8 preterm labors and 2 fetal losses, accounting for the perinatal mortality of 8%. Fetal malformation was not observed. Conclusions While a pregnant woman suffers acute abdominal pain, early diagnosis and severity assessment of AP are very important. Conservative comprehensive treatment with intensive care is recommended. Surgical intervention should be performed as late as possible.展开更多
Management of acute pancreatitis in pregnancy is based on expert opinion only,due to geographic and ethic variations.Nonbiliary causes should be sought as they are associated with worse outcomes.Alcohol as a cause of ...Management of acute pancreatitis in pregnancy is based on expert opinion only,due to geographic and ethic variations.Nonbiliary causes should be sought as they are associated with worse outcomes.Alcohol as a cause of acute pancreatitis is not rare.Hemoconcentration as a marker of fluid def icit and severity should be predicted with caution and fluid resuscitation should be done carefully by closely monitoring the central venous pressure,cardiac and respiratory system.Hypercalcemia of hyperparathyroidism may be falsely lowered due to hypoalbuminemia or suppressed by magnesium tocolysis.展开更多
Summary： Thirty-eight pregnant inpatients with acute pancreatitis （AP） were retrospectively re- viewed from 2006 to 2012 in our hospital. The incidence of pregnancy-associated AP was 2.27%o. Most （78.95%） of the ...Summary： Thirty-eight pregnant inpatients with acute pancreatitis （AP） were retrospectively re- viewed from 2006 to 2012 in our hospital. The incidence of pregnancy-associated AP was 2.27%o. Most （78.95%） of the attack occurred in the third trimester. The median of APACHE II score was 6 and severe AP accounted for 31.58% （12 cases）. Primary diseases were absent in most cases （57.89%） The most common clinical presentations were abdominal pain （89.47%） and vomiting （68.42%）. Pleural effusion and ascites were found only in the third trimester. Elevated white blood cell count, amylase and lipase were commonly found in biochemical examinations. Eleven cases required inten- sive care in ICU and 21 cases received caesarean section. There were 2 maternal deaths and 12 fetal losses including 4 abortions. It is concluded that AP is a rare entity in pregnancy. The incidence of pancreatitis increases with the gestational age. However, the severity is not necessarily related with the pregnancy trimesters. The diagnosis is based on clinical presentations, laboratory tests and imag- ing examinations. Although the treatment strategy of a pregnant woman with pancreatitis is similar to the general non-pregnant patient with AP, a multidisciplinary team consisting of gastroenterologist, gastrointestinal surgeon, radiologist, obstetrician, and ICU doctor should be set up.展开更多
目的:分析妊娠合并急性胰腺炎(acute pancreatitis in pregnancy,APIP)患者的类型、临床特征及预后危险因素,探讨APIP的预防及治疗管理。方法:回顾性分析2012年4月—2022年3月绵阳市中心医院收治的96例APIP患者,包括APIP的病因、严重程...目的:分析妊娠合并急性胰腺炎(acute pancreatitis in pregnancy,APIP)患者的类型、临床特征及预后危险因素,探讨APIP的预防及治疗管理。方法:回顾性分析2012年4月—2022年3月绵阳市中心医院收治的96例APIP患者,包括APIP的病因、严重程度、实验室指标、并发症、治疗及预后等。结果:根据疾病严重程度分组,轻症APIP(mild APIP,MAPIP)49例(51.04%),中重症APIP(moderate severe APIP,MSAPIP)27例(28.12%),重症APIP(severe APIP,SAPIP)20例(20.83%)。疾病越重,患者的超敏C反应蛋白越高,血钙及白蛋白水平越低,差异有统计学意义(均P<0.05)。组间血淀粉酶、血脂肪酶、血糖指标的差异均无统计学意义(P>0.05)。APIP的主要病因为高脂血症(45/96,46.87%),胆源性APIP 28例(29.17%),特发性APIP 23例(23.96%)。合并有糖尿病的患者高脂血症性APIP发生率更高。高脂血症性APIP更容易出现局部或全身并发症,发展为MSAPIP和SAPIP,差异有统计学意义(P<0.001)。APIP患者的病情越重,胎儿丢失率越高,差异有统计学意义(P<0.05),高脂血症性APIP更易出现胎儿丢失,差异有统计学意义(P<0.001)。结论:APIP在妊娠晚期发生率高,高脂血症是首要病因,并且高脂血症性APIP更易重症化。胎儿丢失率与APIP的严重程度密切相关。APIP的早期诊断、严重程度的评估及治疗方法的选择对于母婴预后非常重要。展开更多
文摘Background The acute abdomen remains a challenge for all obstetricians and physicians who take part in the care of women in pregnancy. To add substantially to our understanding of acute pancreatitis （AP） in pregnancy, in particular affirming the increased risks for mother and fetus associated with AP, we explored features of clinical manifestation and the strategy of management of this disease during pregnancy, and its effects on maternal and fetal outcomes. Methods A retrospective review of medical records of all pregnant patients diagnosed with AP admitted to the Department of Obstetrics and Gynecology, Sixth People＇s Hospital Affiliated to Shanghai Jiao Tong University between 2005 and 2010 was performed. Information was collected from presentation, management, and outcome from medical records. Results There were 11 cases in 2010, accounting for 44% of 25 cases. Among these cases, mild AP （MAP） occurred in 15 cases （60%）, while the rest cases were severe AP （SAP） （40%）. The major etiology of AP in pregnancy was due to gallstone and cholecystitis. Clinical features together with elevation of the plasma concentrations of pancreatic enzymes were the cornerstones of diagnosis. Positive conservative treatment was taken in most of the cases （21 cases, 84%） with a favorable outcome. Seven cases of critically ill patients were monitored in intensive care unit, and 4 patients underwent surgical interventions. As a result, all of 25 patients had better prognosis, no maternal death was observed. There were 8 preterm labors and 2 fetal losses, accounting for the perinatal mortality of 8%. Fetal malformation was not observed. Conclusions While a pregnant woman suffers acute abdominal pain, early diagnosis and severity assessment of AP are very important. Conservative comprehensive treatment with intensive care is recommended. Surgical intervention should be performed as late as possible.
文摘Management of acute pancreatitis in pregnancy is based on expert opinion only,due to geographic and ethic variations.Nonbiliary causes should be sought as they are associated with worse outcomes.Alcohol as a cause of acute pancreatitis is not rare.Hemoconcentration as a marker of fluid def icit and severity should be predicted with caution and fluid resuscitation should be done carefully by closely monitoring the central venous pressure,cardiac and respiratory system.Hypercalcemia of hyperparathyroidism may be falsely lowered due to hypoalbuminemia or suppressed by magnesium tocolysis.
文摘Summary： Thirty-eight pregnant inpatients with acute pancreatitis （AP） were retrospectively re- viewed from 2006 to 2012 in our hospital. The incidence of pregnancy-associated AP was 2.27%o. Most （78.95%） of the attack occurred in the third trimester. The median of APACHE II score was 6 and severe AP accounted for 31.58% （12 cases）. Primary diseases were absent in most cases （57.89%） The most common clinical presentations were abdominal pain （89.47%） and vomiting （68.42%）. Pleural effusion and ascites were found only in the third trimester. Elevated white blood cell count, amylase and lipase were commonly found in biochemical examinations. Eleven cases required inten- sive care in ICU and 21 cases received caesarean section. There were 2 maternal deaths and 12 fetal losses including 4 abortions. It is concluded that AP is a rare entity in pregnancy. The incidence of pancreatitis increases with the gestational age. However, the severity is not necessarily related with the pregnancy trimesters. The diagnosis is based on clinical presentations, laboratory tests and imag- ing examinations. Although the treatment strategy of a pregnant woman with pancreatitis is similar to the general non-pregnant patient with AP, a multidisciplinary team consisting of gastroenterologist, gastrointestinal surgeon, radiologist, obstetrician, and ICU doctor should be set up.
文摘目的:分析妊娠合并急性胰腺炎(acute pancreatitis in pregnancy,APIP)患者的类型、临床特征及预后危险因素,探讨APIP的预防及治疗管理。方法:回顾性分析2012年4月—2022年3月绵阳市中心医院收治的96例APIP患者,包括APIP的病因、严重程度、实验室指标、并发症、治疗及预后等。结果:根据疾病严重程度分组,轻症APIP(mild APIP,MAPIP)49例(51.04%),中重症APIP(moderate severe APIP,MSAPIP)27例(28.12%),重症APIP(severe APIP,SAPIP)20例(20.83%)。疾病越重,患者的超敏C反应蛋白越高,血钙及白蛋白水平越低,差异有统计学意义(均P<0.05)。组间血淀粉酶、血脂肪酶、血糖指标的差异均无统计学意义(P>0.05)。APIP的主要病因为高脂血症(45/96,46.87%),胆源性APIP 28例(29.17%),特发性APIP 23例(23.96%)。合并有糖尿病的患者高脂血症性APIP发生率更高。高脂血症性APIP更容易出现局部或全身并发症,发展为MSAPIP和SAPIP,差异有统计学意义(P<0.001)。APIP患者的病情越重,胎儿丢失率越高,差异有统计学意义(P<0.05),高脂血症性APIP更易出现胎儿丢失,差异有统计学意义(P<0.001)。结论:APIP在妊娠晚期发生率高,高脂血症是首要病因,并且高脂血症性APIP更易重症化。胎儿丢失率与APIP的严重程度密切相关。APIP的早期诊断、严重程度的评估及治疗方法的选择对于母婴预后非常重要。
