Clinical Analysis Of Acute Pancreatitis In Pregnancy

Objective:Acute pancreatitis in pregnancy(APIP)is a serious complication of pregnancy,and it is characterized by rapid attack,rapid progression,and severe disease,it will pose a great influence to the life and health of mother and infants.This study aims to investigate the effects of pregnancy factors and different etiologies on disease severity in patients with acute pancreatitis in pregnancy,as well as and the clinical treatment,the pregnancy outcome,and the effects of APIP on mothers and infants,in order to enhance the understanding of APIP and improve the diagnosis,treatment and prognosis of the APIP,and provide reference for clinical work.Methods:A total of 34 patients with APIP who were treated in The Second Hospital affiliated to Jilin University from January 2012 to December 2020 were collected as pregnancy group,and 34 women of childbearing age hospitalized during the same period were regarded as non-pregnancy group.Then the influence of pregnancy on the severity grading and imaging findings of the acute pancreatitis,white blood cell count,erythrocyte deposited,creatinine,blood calcium,blood sugar and other factors.Later,the patients with patients were divided into biliary group,hyperlipidemia group,and other etiological groups according to their pathogenesis to analyze their pregnancy of attack,length of hospital stay,disease severity,laboratory test indexes,treatment,and fetal prognosis were analyzed.Results :1.The comparison between the pregnancy group and the non-pregnancy group showed that there were statistical differences in disease severity and white blood cell count(P<0.05),while there were no significant differences in other indicators such as complications,hematocrit,creatinine,blood calcium,blood glucose,etc(P>0.05).2.The comparison of patients with APIP between different etiologies showed that the levels of blood glucose,triglyceride,D-dimer and fibrinogen in the hyperlipidemia group were significantly higher than those in the biliary group and other groups.The level of white blood cell count in the hyperlipidemia group was higher than that in the biliary group,and the ALT level in the biliary group was higher than that in the hyperlipidemia group,and there were statistically significant differences(P<0.05),but there were no statistically significant differences in other indicators,such as disease severity,imaging findings,hemoglobin content,hematocrit,serum calcium,creatinine,and AST(P>0.05).3.Treatment: All AP patients were first given fasting,fluid infusion,gastric acid inhibition,trypsin inhibition,anti-infection and nutritional support treatment.During the hospitalization,25 patients had termination of pregnancy,and 22 patients received cesarean section,of which 5 received cesarean section plus abdominal tube drainage,including 1 with biliary APIP,2 with hyperlipidemia APIP,and 2 with other etiology.1 biliary patient received laparoscopic cholecystectomy and common bile duct exploration after cesarean section,and 5 patients in the hyperlipidemia group received CRRT+ plasmapheresis.4.Influence on the fetus: 2 cases with fetal death and 3 cases with labor induction occurred in the hyperlipidemia group,and 3 deaths after birth,including 1 in the hyperlipidemia group and 2 in the other etiology group.The fetal death and post-birth severe complications(including stillbirth,stillbirth,induced labor,neonatal respiratory distress syndrome,neonatal cerebral hemorrhage,and sepsis)were observed in the hyperlipidemia group,biliary group and other groups,including 11 cases in the hyperlipidemia group,4 cases in the biliary group,and 6 cases in the other groups.There was no significant statistical difference among these groups(P>0.05).Conclusions:1.APIP patients are more severe and more likely to have systemic inflammatory reactions(systemic inflammatory response syndrome,SIRS)than non-gestational AP patients.2.Hyperlipidemic APIP is more likely to be complicated with abnormal blood glucose and coagulation function than biliary or other etiologies.3.APIP mostly occurs in the middle and late pregnancy,conservative treatment and natural delivery are the first choice for treatment,and cesarean section is required for severe patients.4.APIP can lead to serious complications after the birth of the fetus,and in severe cases,it can lead to stillbirth,which is very harmful to mothers and infants.