pancreatitis en embarazo

1. ACUTE PANCREATITIS
DURING PREGNANCY
DR. MARCELO ALCIVAR LEON
GASTROENTEROLOGO - ENDOSCOPISTA
HOSPITAL CLINICA KENNEDY
HOSPITAL IESS MACHALA

2. Key Points
INTRODUCTION
EPIDEMIOLOGY
RISK FACTORS
CLASIFICATION
MANAGEMENT
CONCLUSIONS

3. Acute pancreatitis is a relatively uncommon disease in
pregnant women (1/1500–4500 pregnancies)
Proposed numerous causes / unpredictable results
Gallstone disease (70%) due to hormonal lithogenic
effects
Its progression can be fatal; fetal losses of up to 4.7% .
Introduction
Saldivar-Rodríguez D, Treviño-Montemayor OR, Guzman-López A, TreviñoMartinez G, Flores-Acosta .Ginecol
Obstet Mex. 2016 feb;84(2):79-83.

4. VARIABLE
1 embarazo de cada
3.300 se complica
con pancreatitis
Swisher et al , 1 de
cada 1.500
Legro y Laifer
hallaron una
incidencia de 1 de
cada 4.000
Enfermedad litiásica
de la vía biliar
destaca como la
causa más frecuente
(67-100%)
• Swisher SG, Hunt KK, Schmit PJ, Hiyama DT, Bennion RS, Thompson JE. Management of pancreatitis
complicating pregnancy. Am Surg. 2016;60:759. 4.
• Legro RS, Laifer SA. First trimester pancreatitis: Maternal and neonatal outcome. J Reprod Med. 2015;40:689.
Epidemiology

5. 1990 0-37%
2000 11-37%,
2010 decrease
Mortality
Augustin G, Majerovic M. Non-obstetrical acute abdomen during pregnancy. Eur J Obstet Gynecol Reprod Biol
2007; 131: 4–12. 8.
Hernandez A, Petrov MS, Brooks DC, Banks PA, Ashley SW, Tavakkolizadeh A. Acute pancreatitis and pregnancy: a
10-year single center experience. J Gastrointest Surg 2007; 11: 1623–1627
AP during pregnancy is a severe disease with a
high maternal– fetal mortality rate (37% and 60%,
respectively) according to old published series of
cases, but this has recently decreased thanks to
earlier diagnosis and some maternal and neonatal
intensive care improvement

6. The most common etiological and risk factors of Acute
Pancreatitis in Pregnancy
Hacker FM, Whalen PS, Lee VR, Caughey AB. Maternal and fetal outcomes of pancreatitis in pregnancy. Am J Obstet
Gynecol 2015;213:568.e1-5.

7. Sludge and stones in gallbladder during pregnancy
Prevalence and risk factors
A. MARINGHINI et al. Journal of Hepatology, 1987; 5:218-223

8. 19%
• 1er Trim
26%
• 2do Trim
53%
• 3er Trim
60%
• Parto
pretérmino
The most common etiological and risk factors
of acute pancreatitis in pregnancy

9. The most common etiological and risk
factors of acute pancreatitis in pregnancy
Hacker FM, Whalen PS, Lee VR, Caughey AB. Maternal and fetal outcomes of pancreatitis in pregnancy. Am J Obstet
Gynecol 2015;213:568.e1-5.

10. Definitions and Classification of AP
Tang SJ, Rodriguez-Frias E, Singh S, Mayo MJ, Jazrawi SF, Sreenarasimhaiah J, et al. Acute pancreatitis during
pregnancy. Clin Gastroenterol Hepatol 2016;8:85-90

11. • Abdominal ultrasound is safe and it has
higher sensitivity than computerized
tomography for detecting gallstones in
cases of AP.
• Magnetic resonance imaging (MRI)
• AP
• complications (edema, pseudocysts or
hemorrhagic pancreatitis)
• Main pancreatic duct is clear or not when
persistent cholestasis occurs.
• NO fetal toxicity even when gadolinium
contrast media
Imaging
Roumieu F, Ponchon T, Audra P, Gaucherand P. Acute pancreatitis in pregnancy: place of the different explorations
(magnetic resonance cholangiopancreatography, endoscopic ultrasonography) and their therapeutic consequences. Eur J
Obstet Gynecol Reprod Biol 2008; 140: 141–142.

12. Definitions and Classification of AP
Tang SJ, Rodriguez-Frias E, Singh S, Mayo MJ, Jazrawi SF, Sreenarasimhaiah J, et al. Acute pancreatitis during
pregnancy. Clin Gastroenterol Hepatol 2016;8:85-90

13. Differential diagnosis of Acute Pancreatitis in
Pregnancy
Click B, Ketchum AM, Turner R, Whitcomb DC, Papachristou GI, Yadav D. The role of apheresis in hypertriglyceridemia
induced acute pancreatitis: a systematic review. Pancreatology 2015;15:313-320.

14. Algorithm of
treatment in acute
biliary pancreatitis in
pregnant women
Acute pancreatitis during pregnancy G
Ducarme et al. Journal of Perinatology
(2014), 87 – 94

16. Cirugia Española 2014, 92 (7): 468 - 471

17. Revista Facultad de Salud - RFS - Julio - Diciembre.

18. International Journal of Applied and Basic Medical Research, Jul-Dec 2013, Vol 3, Issue 2
Conservative medical management of acute pancreatitis was the
main stay of treatment. Surgical management (laparoscopic
cholecystectomy) was carried out for the underlying cause
(cholelithiasis) in three patients. One patient underwent ERCP for
CBD stone

19. SUMMARY

20. A multidisciplinary approach, including gastroenterology and obstetric care,
seems to be a key in making the best choice for management of AP during
pregnancy
Traditionally conservative, the treatment of biliary lithiasis depends on the
symptoms.
There is no consensus in the literature regarding the management of AP during
pregnancy.
AP during pregnancy is a rare but severe disease.
CONCLUSIONS