Acute pancreatitis during pregnancy: A case report

Document Type : Case report


1 Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Associate professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Assistant professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Resident, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

5 General Physician, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.


Introduction: Acute pancreatitis during pregnancy is a rare event that its frequency has been estimated as ranging from of 1/1000 to 1/10000 births. The aim of this study was to report a case of acute pancreatitis during pregnancy and its maternal and neonatal outcomes following conservative management.
Case presentation: A 25 years old woman G2ab1(second pregnancy, one abortion) with gestational age of 30 weeks and sudden epigastria pain from the last night who had referred to the Ghaem hospital of Mashhad due to severe stomach pain along with nausea and vomiting.. MRI reported increase in gall bladder thickness and pancreatic inflammation and left plural effusion. In laboratory tests, amylase and lipase were three time higher than normal. With diagnosis of pancreatitis, the patient underwent conservative treatment. At 6th day of hospitalization, 38°C fever and uterine contractions were started. A preterm neonate was born. The mother and neonate discharged from the hospital with good conditions.
Conclusion: Acute pancreatitis during pregnancy can lead to preterm delivery. Early diagnosis and conservative treatment can be associated with desirable maternal and neonatal outcomes. 


  1. 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(12):1623-7.
  2. Pitchumoni CS, Yegneswaran B. Acute pancreatitis in pregnancy. World J Gastroenterol 2009; 15(45):5641-6.
  3. Gilbert A, Patenaude V, Abenhaim HA. Acute pancreatitis in pregnancy: a comparison of associated conditions, treatments and complications. J Perinat Med 2014; 42(5):565-70.
  4. Nelson DB, Yost NP, Cunningham FG. Acute fatty liver of pregnancy: clinical outcomes and expected duration of recovery. Am J Obstet Gynecol 2013; 209(5):456.e1-7.
  5. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al. Williams Obstetrics. 24th ed. New York: McGraw-Hill; 2014. p. 1097.
  6. Warshaw AL. Improving the treatment of necrotizing pancreatitis--a step up. N Engl J Med 2010; 362(16):1535-7.
  7. Tang SJ, Rodriguez-Frias E, Singh S, Mayo MJ, Jazrawi SF, Sreenarasimhaiah J, et al. Acute pancreatitis during pregnancy. Clin Gastroenterol Hepatol 2010; 8(1):85-90.
  8. Ducarme G, Châtel P, Alves A, Hammel P, Luton D. Management of necrotizing pancreatitis in the third trimester of pregnancy. Arch Gynecol Obstet 2009; 279(4):561-3.
  9. Whitcomb DC. Clinical practice. Acute pancreatitis. N Engl J Med 2006; 354(20):2142-50.
  10. Hacker FM, Whalen PS, Lee VR, Caughey AB. Maternal and fetal outcomes of pancreatitis in pregnancy. Am J Obstet Gynecol 2015; 213(4):568.e1-5.
  11. Sun L, Li W, Sun F, Geng Y, Tong Z, Li J. Intra-abdominal pressure in third trimester pregnancy complicated by acute pancreatitis: an observational study. BMC Pregnancy Childbirth 2015; 15:223.
  12. Papadakis EP, Sarigianni M, Mikhailidis DP, Mamopoulos A, Karagiannis V. Acute pancreatitis in pregnancy: an overview. Eur J Obstet Gynecol Reprod Biol 2011; 159(2):261-6.
  13. Angelini DJ. Gallbladder and pancreatic disease during pregnancy. J Perinat Neonatal Nurs 2002; 15(4):1-12.
  14. Kayataş SE, Eser M, Cam C, Cogendez E, Guzin K. Acute pancreatitis associated with hypertriglyceridemia: a life-threatening complication. Arch Gynecol Obstet 2010; 281(3):427-9.
  15. Dabbas N, Abdelaziz M, Hamdan K, Stedman B, Abu Hilal M. Gallstone-induced perforation of the common bile duct in pregnancy. HPB Surg 2008; 2008:174202.
  16. Koo BC, Chinogureyi A, Shaw AS. Imaging acute pancreatitis. Br J Radiol 2010; 83(986):104-112.
  17. Bolukbas FF, Bolukbas C, Horoz M, Ince AT, Uzunkoy A, Ozturk A, et al. Risk factors associated with gallstone and biliary sludge formation during pregnancy. J Gastroenterol Hepatol 2006; 21(7):1150-3.
  18. Masselli G, Brunelli R, Casciani E, Polettini E, Bertini L, Laghi F, et al. Acute abdominal and pelvic pain in pregnancy: MR imaging as a valuable adjunct to ultrasound? Abdom Imaging 2011; 36(5):596-603.
  19. Yang AL, Vadhavkar S, Singh G, Omary MB. Epidemiology of alcohol-related liver and pancreatic disease in the United States. Arch Intern Med 2008; 168(6):649-56.
  20. Wu BU, Hwang JQ, Gardner TH, Repas K, Delee R, Yu S, et al. Lactated Ringer's solution reduces systemic inflammation compared with saline in patients with acute pancreatitis. Clin Gastroenterol Hepatol 2011; 9(8):710-717.e1.
  21. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 2013; 13(4 Suppl 2):e1-15.
  22. Wu BU, Johannes RS, Sun X, Conwell DL, Banks PA. Early changes in blood urea nitrogen predict mortality in acute pancreatitis. Gastroenterology 2009; 137(1):129-35.
  23. Tenner S, Baillie J, DeWitt J, Vege SS; American College of Gastroenterology. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol 2013; 108(9):1400-15.
  24. Moraes JM, Felga GE, Chebli LA, Franco MB, Gomes CA, Gaburri PD, et al. A full solid diet as the initial meal in mild acute pancreatitis is safe and result in a shorter length of hospitalization: results from a prospective, randomized, controlled, double-blind clinical trial. J Clin Gastroenterol 2010; 44(7):517-22.