Maternal and perinatal outcomes in acute pancreatitis complicating pregnancy: a case series and review of literature

Abstract

Acute pancreatitis in pregnancy (APIP) is uncommon but can be a serious maternal and obstetric emergency. Its symptoms may resemble common pregnancy-related complaints, making early diagnosis challenging, particularly in the third trimester. We report three cases of APIP presenting in the third trimester. Case 1 was a 23-year-old G2P1L0 at 31 weeks who presented with severe epigastric pain, vomiting, and preterm labour. Markedly elevated amylase and lipase, along with imaging findings of acute necrotizing pancreatitis with limited pancreatic necrosis, extensive peripancreatic inflammation, collections, mild ascites, ileus, and left pleural effusion, confirmed the diagnosis. Fetal distress subsequently developed, necessitating emergency caesarean delivery. She required postoperative intensive care and ventilatory support. Case 2, a multigravida at 33+5 weeks with recurrent pancreatitis, fetal growth restriction, and anemia, presented with abdominal pain and reduced fetal movements. She improved with conservative management and later underwent induction at 35+5 weeks, resulting in a live preterm vaginal delivery. Case 3, a primigravida at 31+5 weeks with gestational hypertension and intrahepatic cholestasis, presented with epigastric pain radiating to the back and shoulder. Elevated pancreatic enzymes confirmed pancreatitis. She responded well to conservative treatment and subsequently delivered vaginally. All patients received bowel rest, intravenous fluids, electrolyte correction, analgesia, antibiotics, and close maternal-fetal monitoring. Maternal survival was 100%, and all pregnancies resulted in live preterm births. Early recognition and multidisciplinary management are crucial for favourable outcomes in APIP.