title: Management of hypertriglyceridaemia-induced acute pancreatitis in pregnancy.
abstract: BACKGROUND
  Acute pancreatitis is a recognised rare complication in pregnancy. The reported incidence varies between 3 and 7 in 10 000 pregnancies and is higher in the third trimester. The commonest causes in pregnancy include gallstones, alcohol and hypertriglyceridaemia. Non-gallstone pancreatitis is associated with more complications and poorer outcome with hypertriglyceridaemia-induced acute pancreatitis having mortality rates ranging from 7.5 to 9.0% and 10.0 to 17.5% for mother and foetus, respectively.
  
  
  METHODS
  A 40-year-old para 4 woman, who presented at 15(+4) weeks' gestation, was diagnosed with acute pancreatitis. Past medical history included Graves' disease and hypertriglyceridaemia. Fenofibrate was discontinued immediately after discovery of the pregnancy. Initial investigations showed elevated amylase (475.0 µ/L) and triglycerides (46.6 mmol/L). Imaging revealed an inflamed pancreas without evidence of biliary obstruction/gallstones hence confirming the diagnosis of hypertriglyceridaemia-induced acute pancreatitis. Laboratory tests gradually improved (triglyceride 5.2 mmol/L on day 17). On day 18, ultrasound confirmed foetal demise (18(+1) weeks) and a hysterotomy was performed as she had had four previous caesarean sections.
  
  
  CONCLUSIONS
  Management of acute pancreatitis in pregnancy requires a multi-disciplinary approach. Hypertriglyceridaemia-induced acute pancreatitis has poor outcomes when diagnosed in early pregnancy. Identifying those at risk pre-pregnancy and antenatally can allow close monitoring through pregnancy to optimise care.
authors: Department of Obstetrics and Gynaecology .
authors: Tejal
authors: T
authors: Amin
authors: Leona C Y
authors: LC
authors: Poon
authors: T G
authors: TG
authors: Teoh
authors: K
authors: K
authors: Moorthy
authors: Stephen
authors: S
authors: Robinson
authors: Nicola
authors: N
authors: Neary
authors: Jonathan
authors: J
authors: Valabhji
mesh_terms: D000328:Adult; D005260:Female; D005313:Fetal Death; D006801:Humans; D015228:Hypertriglyceridemia / Q000150:complications*; D010195:Pancreatitis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy
keywords: Acute pancreatitis; hypertriglyceridaemia; management; pregnancy