Acute Pancreatitis in Pregnancy and Puerperium: Assessing Maternal and Fetal Impact, Etiologies, and Clinical Outcomes at a Tertiary Care Hospital in Pakistan

Introduction The association of acute pancreatitis with adverse obstetric outcomes remains subject to great controversy. Outcomes are affected by the standard of care available, and hence, will be better in developed countries than in underdeveloped countries like Pakistan. Therefore, this study aimed to understand the clinical characteristics and treatment of acute pancreatitis in pregnancy (APIP) and its associated maternal and neonatal outcomes in a tertiary care hospital in Pakistan. Methodology A retrospective clinical analysis of APIP cases during pregnancy and the postpartum period was conducted at Aga Khan University Hospital (AKUH) in Karachi, Pakistan, from January 1, 2015, to December 31, 2021. Data were collected from the medical records of women diagnosed with APIP. Pregnant women with chronic and recurrent pancreatitis were excluded. We analyzed baseline demographics, obstetric outcomes, and neonatal outcomes for those who delivered at AKUH. These individuals were monitored in postnatal outpatient clinics to track changes in their initial symptoms. Data were analyzed using IBM SPSS version 25.0. Results A total of 32 patients with APIP were included. Among them, 13 (40.6%) were primigravida, and 21 (65.6%) were multigravida. The majority 22 (69%) presented in the third trimester. The most common etiology was gallstones 13 (40.6%), followed by idiopathic causes 12 (37.5%), and hypertriglyceridemia 2 (6.3%). The disease course remained mild in 24 (75%) of patients, moderate in 5 (15.6%), and severe in 3 (9.4%) according to The Atlanta Criteria. Conservative management was successful in 27 (84.4%), while 5 (15.6%) of patients required surgical intervention. Severe disease courses led to organ dysfunction and disseminated intravascular coagulation in 5 (15.6%), and maternal mortality in 3 (9.4%). Preeclampsia was the most common obstetric complication (6 (18.8%)), and 13 (40.6%) patient underwent an emergency cesarean section. In the mild group, one patient experienced miscarriage, and 14 (43.7%) patients preterm births, with 6 (18.8%) of these newborns requiring NICU admissions and 2 (6.3%) experiencing perinatal mortality. In the severe group, 2 (6.3%) had intrauterine fetal demise. Post-delivery, 12 (37.5%) were lost to follow-up. However, among the patients who followed up, 21 (62.5%) experienced an improvement in their general health condition. Conclusions Our study underscores the increased risk of preeclampsia and preterm births in women with APIP, emphasizing the need for heightened vigilance in disease progression and antenatal care.