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Management of hypertriglyceridaemia-induced acute pancreatitis in pregnancy

Research output: Contribution to journalArticle

Tejal Amin, Leona Poon, TG Teoh, Krishna Moorthy, Stephen Robinson, Nicola Neary, Jonathan Valabhji

Original languageEnglish
Number of pages5
JournalJOURNAL OF MATERNAL FETAL AND NEONATAL MEDICINE
DOIs
Publication statusE-pub ahead of print - 2014

King's Authors

Abstract

Introduction:
Acute pancreatitis is a recognised rare complication in pregnancy. The reported incidence varies between 3 to 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 7.5-9.0% and 10.0-17.5% for mother and fetus, respectively.

Case History:
A 40-year-old para 4 woman, who presented with epigastric pain and vomiting at 15+4 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 u/L) and triglycerides (46.6 mmol/L). The patient was admitted to High Dependency Unit for supportive management with antibiotics, sliding scale and parenteral nutrition commenced on day 8. 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) but anaemia was diagnosed which required 2 units of blood transfusion. On day 18 ultrasound confirmed fetal demise (18+1 weeks) and a hysterotomy was performed as she had had 4 previous caesarean sections.

Conclusion:
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.

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