Revisiones_bibliográficas TyO_Web: Pancreatitis y embarazo / Pancreatitis in pregnancy

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sábado, 4 de febrero de 2017

Pancreatitis y embarazo / Pancreatitis in pregnancy

Febrero 4, 2017. No. 2590

Pancreatitis y embarazo. Etiología, tratamiento y evolución

Pancreatitis in pregnancy: etiology, diagnosis, treatment, and outcomes.

Mali P1.

Hepatobiliary Pancreat Dis Int. 2016 Aug;15(4):434-8.

Abstract

BACKGROUND: Acute pancreatitis in pregnancy is a rare and dangerous disease. This study aimed to examine the etiology, treatment, and outcomes of pancreatitis in pregnancy. METHOD: A total of 25 pregnant patients diagnosed with pancreatitis during the period of 1994 and 2014 was analyzed retrospectively. RESULTS: The pregnant patients were diagnosed with pancreatitis during a period of 21 years. Most (60%) of the patients were diagnosed with pancreatitis in the third trimester. The mean age of the patients at presentation was 25.7 years, with a mean gestational age of 24.4 weeks. Abdominal pain occurred in most patients and vomiting in one patient was associated hyperemesis gravidarum. The common cause of the disease was gallstone-related (56%), followed by alcohol-related (16%), post-ERCP (4%), hereditary (4%) and undetermined conditions (20%). The level of triglycerides was minimally high in three patients. ERCP and wire-guided sphincterotomy were performed in 6 (43%) of 14 patients with gallstone-related pancreatitis and elevated liver enzymes with no complications. Most (84%) of the patients underwent a full-term, vaginal delivery. There was no difference in either maternal or fetal outcomes after ERCP. CONCLUSIONS: Acute pancreatitis is rare in pregnancy, occurring most commonly in the third trimester, and gallstones are the most common cause. When laparoscopic cholecystectomy is not feasible and a common bile duct stone is highly suspected on imaging, endoscopic sphincterotomy or stenting may help to prevent recurrence and postpone cholecystectomy until after delivery.

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Hipertrigliciridemia gestacional severa . Abordaje práctico para clínicos

Severe gestational hypertriglyceridemia: A practical approach for clinicians.

Wong B1, Ooi TC2, Keely E2.

Obstet Med. 2015 Dec;8(4):158-67. doi: 10.1177/1753495X15594082. Epub 2015 Aug 21.

Abstract

Severe gestational hypertriglyceridemia is a potentially life threatening and complex condition to manage, requiring attention to a delicate balance between maternal and fetal needs. During pregnancy, significant alterations to lipid homeostasis occur to ensure transfer of nutrients to the fetus. In women with an underlying genetic predisposition or a secondary exacerbating factor, severe gestational hypertriglyceridemia can arise, leading to devastating complications, including acute pancreatitis. Multidisciplinary care, implementation of a low-fat diet with nutritional support, and institution of a hierarchical therapeutic approach are all crucial to reduce maternal and fetal morbidity. To avoid maternal pancreatitis, close surveillance of triglycerides throughout pregnancy with elective hospitalization for refractory cases is recommended. Careful dietary planning is required to prevent neural and retinal complications from fetal essential fatty acid deficiency. Questions remain about the safety of fibrates and plasmapheresis in pregnancy as well as the optimal timing for induction and delivery of these women.

KEYWORDS: High-risk pregnancy; complications; hypertriglyceridemia; maternal morbidity; maternal-fetal medicine; pancreatitis

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Presentación y manejo de la pancreatitis por hipertricliciridemia en el embarazo. Informe de caso

Presentation and management of acute hypertriglyceridemic pancreatitis in pregnancy: A case report.

Lim R1, Rodger SJ2, Hawkins TL3.

Obstet Med. 2015 Dec;8(4):200-3. doi: 10.1177/1753495X15605697. Epub 2015 Oct 7.

Abstract

Pancreatitis related to hypertriglyceridemia can occasionally occur during pregnancy, particularly if there are underlying genetic abnormalities in lipid metabolism. We report the case of a 27-year-old female with hypertriglyceridemic pancreatitis in pregnancy that was treated initially with lipid lowering medications, followed by plasma exchange for persistently elevated triglyceride levels. Despite multiple interventions, she developed recurrent pancreatitis and simultaneously had a preterm birth. In this case report, we highlight the various therapies and the use of plasmapharesis in secondary prevention of hypertriglyceridemic pancreatitis in pregnancy.

KEYWORDS: Pregnancy; hyperlipidemia; hypertriglyceridemia; pancreatitis; plasmapheresis

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