Medical treatment mirrors that for nonpregnant patients. This includes analgesics, IV hydration, and measures to decrease pancreatic secretion by interdiction of oral intake. Other than supportive therapy, antibiotics when appropriate, and targeted surgical interventions in the case of gallstone pancreatitis, no particular treatment schemes have improved outcomes. In a series by Ramin and colleagues (1995), all 43 afected pregnant women responded to conservative treatment and were hospitalized for a mean of8.5 days. Nasogastric suction does not improve outcomes of mild to moderate disease, but enteral feeding may be helpul once pain improves and associated ileus resolves. For women with more severe pancreatitis and a prolonged disease course, total enteral nutrition using nasojejunl feeding is superior to total parenteral nutrition (Cain, 2015; Conwell, 2015). If there is bacterial superinfection of necrotizing pancreatitis, sepsis, or cholangitis, then broad-spectrum antimicrobials are administered. If common duct stones are found, then ERCP is indicated (Fogel, 20 14; Tang, 2010). Cholecystectomy is considered after inflammation subsides because women with galls tonic pancreatitis carry an increased risk of recurrent pancreatitis (Cain, 2015).
Pregnancy outcomes are afected by acute pancreatitis severity. Eddy and associates (2008) reported a 30-percent preterm delivery rate, and 11 percent were delivered before 35 weeks' gestation. There were two pancreatitis-related maternal deaths. Importantly, almost a third of 73 women had recurrent pancreatitis during pregnancy. Of the 342 pregnancies complicated by pancreatitis in the California study, preterm delivery and fetal mortality rates were increased (Hacker, 2015). Also, preeclampsia risk was increased fourfold.
Few reports describe pregnancy following pancreas transplantation. Of 44 pregnancies in 73 women following pancreaskidney transplantation, outcomes are encouraging, and vaginal delivery has been described CMastrobattista, 2008). Although the incidence of hypertension, preeclampsia, preterm delivery, and fetal-growth restriction are high, there was only one perinatal death. Four rejection episodes developed during pregnancy and were treated successfully. Pancreatic islet autotransplanta tion may be performed to prevent diabetes following pancre
Serum lipase 3076 36-41,824 atectomy, and at least three successful pregnancies have been 1.7 0.1-8.71 0.2-1.3 reported (J ung, 2007).
Leukocytes 10,700 1000-27,200 3900-10,700 Abu-Hayyeh S, Ovadia C, Lieu T, et al: Prognostic and mechanistic potenrial of progesterone sulfates in inrrahepatic cholestasis of pregnancy and pruritus gravidarum. Hepatology ,t2016
Agrawal S, Agarwal S, Arnason T, et al: Management of hepatocellular ade
From Ramin, 1995; Tang, 201n0; Turhan, 2010.
noma: recent advances. Clin Gastroenrerol Hepatol 13: 1221, 2015 iroldi J, Berghella V: Hepatitis C and pregnancy. Obstet Gynecol Surv 61(10):666,s2006
American Academy of Pediatrics and the merican College of Obstetricians and Gynecologists: Guidelines for Perinatal Care, 8th ed. Elk Grove Village, AAP, 2017