Background: Acute pancreatitis (AP) in pregnancy is rare, and little is known about the natural history of this disease in this patient population. We report our institutional experience with AP in this subgroup of patients.
Methods: A retrospective review of the medical records from a single institution, Brigham and Women's Hospital, over a 10-year period (1996 to 2006) was performed. Records of patients diagnosed with AP while pregnant were reviewed, and assessed for demographics, gestational age (GA), etiology, management, length of stay (LOS), and maternal and fetal outcomes. Intergroup comparisons were performed using ANOVA, with p<0.05 taken as significant.
Results: We identified 21 patients, who presented with 34 episodes. Seven patients had more than one attack of AP. Mean age at presentation was 27.6 years (18-40 range). Etilogy is summarized in Table 1. Attacks of AP occurred predominantly in the second and third trimester (2 episodes in first, 19 in second, and 13 in third trimester). Six (50%) of the 12 patients diagnosed with B-AP eventually underwent cholecystectomy (CCY); in a third of these cases initial conservative therapy had failed. The other patients with B-AP underwent endoscopic sphincterotomy (ES) (n=2, 17%), and 4 were treated conservatively with no further intervention (OBS) (33%). 50% of those in the OBS group had recurrent AP requiring hospital admission, whereas there were no readmissions in the CCY group (follow up in CCY group 66%). There were no significant differences in LOS between various treatment groups in patients with B-AP (CCY (7.8) vs. ES (5.0) vs. OBS (3.6), p>0.05). There were no maternal deaths; there were 4 pre-term labors and 1 fetal loss, although there were not chronologically related to the episode of the pancreatitis.
Discussion: AP in pregnancy remains a rare condition. B-AP patients appear to have a high relapse rate, and CCY is recommended in this group, ideally during the same hospital admission. This surgical approach is not associated with an increase in LOS, or maternal or fetal complication rates.
Etilogy of AP in Pregnancy Women

Etiology	Mean age (yrs)	No of pt	No of episodes
B-AP	25.9	12 (62%)	16 (47%)
Undetermined	27.6	6 (24%)	14 (41%)
Others	29	3 (14%)	4 (12%)