Article

Recurrent hypertriglyceridemia-induced pancreatitis in pregnancy: A management dilemma

Department of Obstetrics and Gynecology, American University of Beirut, Beyrouth, Beyrouth, Lebanon
Pancreas (Impact Factor: 3.01). 04/2006; 32(2):227-8. DOI: 10.1097/01.mpa.0000202943.70708.2d
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Available from: Anwar H Nassar, Sep 10, 2014
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    • "Although heparin is an option to control triglyceride levels, women with acute pancreatitis are at risk for life threatening hemorrhage within the pancreas, and therefore heparin could conceivably worsen the ultimate outcome. Additionally lipid lowering medication or plasma exchange has also been described in the literature as alternative therapies [1] [3] [6]. "
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    ABSTRACT: Background. We report a case of familial hyperlipidemia in pregnancy that resulted in hemorrhagic pancreatitis. Case. A patient at 27-week gestation was admitted for recurrent pancreatitis secondary to severe hyperlipidemia. With conservative care, the patient improved but on the fourth day of admission she experienced a sudden onset of hypotension and was diagnosed with hemorrhagic pancreatitis. Conclusion. Pancreatitis caused by hyperlipidemia is an uncommon event during pregnancy. A familiarity with the severe complications associated with this potentially life-threatening condition is important.
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    ABSTRACT: We present two cases of severe hypertriglyceridemia (HTG > 10 g/l) in pregnancy. The first reports the case of a primigravida with mild HTG before conception. Triglycerids (TG) increased thereafter (20.9 g/l) during pregnancy causing pancreatitis and in utero fetal death at 24 weeks’ gestation (WG). The second deals with the de novo occurrence of a severe HTG (19 g/l) diagnosed incidentally at 34 WG and complicated by acute renal failure. Severe HTG in pregnancy threatens maternal and fetal prognosis. We have summarized the curative and preventive management of gravidic HTG.
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    ABSTRACT: To estimate the incidence, cause, and complications of pancreatitis in pregnancy and to identify factors associated with adverse outcomes. This study was a chart review of all pregnant patients diagnosed with pancreatitis from 1992-2001 at 15 participating hospitals. Information was collected on presentation, management, and outcome, along with the number of deliveries at each hospital. During the 10 years of the study, 101 cases of pancreatitis occurred among 305,101 deliveries, yielding an incidence of one in 3,021 (.03%). There were no maternal deaths; perinatal mortality was 3.6%. Eighty-nine women had acute pancreatitis, and 12 women had chronic pancreatitis. The majority (66%) of cases of acute pancreatitis were biliary in origin, and they were associated with better outcomes than nonbiliary causes. Cases of gallstone pancreatitis that received surgical or endoscopic intervention during pregnancy had lower rates of preterm delivery and recurrence than those that were conservatively managed, but this difference was not significant (P=.2). Alcohol was responsible for 12.3% of acute pancreatitis cases and 58% of chronic pancreatitis cases and was associated with increased rates of recurrence and preterm delivery. A calcium level, triglycerides, or both was not obtained in half of cases identified as idiopathic. Pancreatitis is a rare event in pregnancy, occurring in approximately 3 in 10,000 pregnancies. Although it is most often acute and related to gallstones, nonbiliary causes should be sought because they are associated with worse outcomes. III.
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