Introduction Placental abruption secondary to pancreatitis is rare. There are two cases in the literature. There are no previous reported cases of placental abruption secondary to pancreatitis caused by hypertriglyceridaemia.
Case We present the case of a 30 year old low risk primagravida who presented at 39 weeks and 6 days gestation with severe epigastric pain. Her bedside observations revealed tachypnoea but were otherwise normal. Urinalysis revealed proteinuria (++). Vaginal examination was consistent with early labour. Initial differential diagnosis included a surgical emergency, pre-eclampsia, labour and placental abruption. Initial CTG was normal but became pathological and she went on to have emergency caesarean section within two hours of arrival. Operative findings included milky white ascitic fluid on opening the abdomen and a retroplacental clot. Chemical pathology telephoned to inform the team that her blood tests appeared lipaemic and she had an amylase of 1043 U/L (20–120 U/L) and triglycerides of 134 mmol/L (<1.70 mmol/L). She was transferred to intensive care and has had a complicated recovery, which included cardiac arrest on her first postoperative day. At the time of writing, she remains on intensive care (her seventh week) and is being considered for a pancreatectomy for severe haemorrhagic pancreatitis.
Conclusion Acute pancreatitis should be considered in all patients presenting with upper abdominal pain. It can be difficult to diagnose and present non-specifically, particularly in the latter stages of pregnancy. It is an important cause of abruption. Triglycerides increase in pregnancy and are a well established cause of pancreatitis.
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