Defined, low threshold for caesarean section and multidisciplinary team management improves fetal outcome from acute pancreatitis in pregnancy

Wenhua He; Zhi Zhang; Wenhao Cai; Lingyu Luo; Hongrong Xu; Lei Li; Jiarong Li; Liang Xia; Yong Zhu; Pi Liu; Hao Zeng; Chunshui Cao; Haiming Chen; Gaole Yuan; Chen Yu; Junhui Wan; Peter Szatmary; Robert Sutton; Yin Zhu; Nonghua Lu

doi:10.1016/j.pan.2023.05.009

Defined, low threshold for caesarean section and multidisciplinary team management improves fetal outcome from acute pancreatitis in pregnancy

Pancreatology. 2023 Aug;23(5):473-480. doi: 10.1016/j.pan.2023.05.009. Epub 2023 May 21.

Authors

Wenhua He¹, Zhi Zhang², Wenhao Cai³, Lingyu Luo⁴, Hongrong Xu⁴, Lei Li⁴, Jiarong Li⁴, Liang Xia⁴, Yong Zhu⁴, Pi Liu⁴, Hao Zeng⁴, Chunshui Cao⁵, Haiming Chen⁶, Gaole Yuan⁷, Chen Yu⁸, Junhui Wan², Peter Szatmary⁹, Robert Sutton¹⁰, Yin Zhu¹¹, Nonghua Lu¹²

Affiliations

¹ Pancreatic Disease Centre, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China; Liverpool Pancreatitis Research Group, Liverpool University Hospitals NHS Foundation Trust and Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.
² Department of Gynecology and Obstetrics, The First Affiliated Hospital of Nanchang University, Nanchang, China.
³ Liverpool Pancreatitis Research Group, Liverpool University Hospitals NHS Foundation Trust and Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China.
⁴ Pancreatic Disease Centre, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
⁵ Department of Emergency, The First Affiliated Hospital of Nanchang University, Nanchang, China.
⁶ Department of Emergency Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.
⁷ Department of Pediatrics, Neonatal Intensive Care Unit, The First Affiliated Hospital of Nanchang University, Nanchang, China.
⁸ Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
⁹ Liverpool Pancreatitis Research Group, Liverpool University Hospitals NHS Foundation Trust and Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.
¹⁰ Liverpool Pancreatitis Research Group, Liverpool University Hospitals NHS Foundation Trust and Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK. Electronic address: [email protected].
¹¹ Pancreatic Disease Centre, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China. Electronic address: [email protected].
¹² Pancreatic Disease Centre, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China. Electronic address: [email protected].

PMID: 37263836
DOI: 10.1016/j.pan.2023.05.009

Abstract

Background: Acute pancreatitis in pregnancy (APIP) is associated with increased maternal and fetal mortality.

Objectives: We sought to determine whether a low threshold for cesarean section (C-section) in severe acute pancreatitis (SAP) or Predict SAP improves maternal and fetal outcomes in patients with APIP.

Methods: We identified patients with APIP at a single institution from a prospective database and studied fetal and maternal health in APIP before (2005-2014) and after (2015-2019) introduction of multidisciplinary team management with a defined, lowered threshold for C-section. The primary end point was fetal mortality comprising abortion and perinatal death. Risk factors associated with fetal mortality were analyzed by univariable and multivariable logistic regression analysis.

Results: A total of 165 patients with APIP were eligible for analysis. There was a highly significant increase in patients undergoing C-section from 37 (30.8%) of 120 during 2005-2014 to 27 (60%) of 45 in 2015-2019 (P = 0.001), with a highly significant fall in fetal mortality from 37 (30.8%) of 120 to 3 (6.7%) of 45 between the same periods (P = 0.001), when maternal mortality fell from 6 to zero (P = 0.19). Maternal early systemic inflammatory response syndrome (SIRS) (odds ratio [OR] 6.98, 95% confidence interval [CI] 1.53, 30.80, P = 0.01) and SAP (OR 3.64, 95%CI 1.25, 10.60, P = 0.02) were two independent risk factors associated with fetal mortality.

Conclusions: Multidisciplinary collaboration and a defined, low threshold for C-section improve fetal outcomes in patients with APIP.

Keywords: Acute pancreatitis; Cesarean section; Fetal mortality; Multidisciplinary team; Pregnancy.

MeSH terms

Acute Disease
Cesarean Section / adverse effects
Female
Humans
Pancreatitis* / complications
Patient Care Team
Pregnancy