ACUTE PANCREATITIS: AS A REASON FOR PRETERM DELIVERY

Abstract

Acute pancreatitis which is the rare reason for acute abdomen during pregnancy could cause morbidity or mortality. Physiologic changes of pregnancy affect the gall bladder and bile ingredients which play a crucial role in acute pancreatitis. Damage in the pancreas initiates local inammation and damage in the pancreas however, systemic inammatory response and multi-organ dysfunction are not rare. Additionally, acute pancreatitis during pregnancy could be a reason for preterm delivery as we aimed to present two cases in the last trimester of the pregnancy. Case 1: rd A 19-year-old woman in her 33 gestational week of pregnancy was admitted to the emergency room with acute abdominal pain and vomiting for 4 hours. She had a rm cervix on vaginal examination and ultrasonographic evaluation revealed a live fetus with a 2620 gr of estimated fetal weight, normal amniotic uid index, and placenta. Laboratory tests presented as elevated serum amylase and lipase. A hydropic gallbladder with multiple gall stones was detected in the abdominal ultrasound. The patient was hospitalized with an acute pancreatitis diagnosis. During the hospital stay, uterine th contractions had initiated and cervical dilation has progressed. The patient was delivered a live baby and discharged on the 7 hospital stay. She was performed laparoscopic cholecystectomy 4 weeks after the delivery. Case 2: th A 28-year-old woman in her 35 gestational week was admitted to the emergency department with right upper quadrant pain. Abdominal and obstetric ultrasounds were uneventful. Laboratory examination revealed an elevated serum amylase and lipase. She was hospitalized. During the hospital stay; despite the medical treatments and prevention of oral intake, the levels of amylase and lipase and the abdominal pain have progressed. The patient was delivered via cesarean section. The levels of amylase and lipase decreased progressively, and the upper quadrant abdominal pain gradually decreased. The patient was discharged on day 7. Discussion: Acute pancreatitis could cause a systemic inammatory response which could lead to preterm delivery. Upper abdominal pain is the essential symptom and elevated serum amylase and lipase about 3-fold are the most common nding. Ultrasonographic evaluation of the gall-bladder and pancreas is crucial. Magnetic resonance cholangiopancreatography without contrast medium can also be used for diagnosis. A multidisciplinary approach is essential for treatment and follow-up. Obstetricians should evaluate fetal well being, and consider acute pancreatitis as a reason for threatened preterm labor.