Acute pancreatitis during pregnancy

• Incidence is 1:1000–10,000 pregnancies

• More commonly affects multiparous individuals (75%)

• The majority of cases occur in the third trimester (50%), followed by the early postpartum period (38%), and the first and second trimester (12%)

most commonly gallstones, heavy alcohol use, and familial hypertriglyceridemia

• Physiologic changes during pregnancy such as altered progesterone and estrogen levels increase the risk of choledocholithiasis.

• ↑ Progesterone → ↑ pressure on the sphincter of Oddi → bile stasis

• Estrogen alters the composition of bile, making it more lithogenic.

• CBC

  • May show physiologic alterations due to pregnancy (e.g., leukocytosis, increased serum amylase and lipase)

  • If amylase and/or lipase are > 3 times greater than normal, acute pancreatitis is likely [47]

• Imaging: abdominal ultrasound or MRI are preferred (e.g., to identify choledocholithiasis or complications of acute pancreatitis such as hemorrhage, edema, or pseudocysts)

• Identical to that for nonpregnant individuals