Zsombor Marton

Background/Objectives: Acute pancreatitis in pregnancy and the early postpartum period (APIP) is an uncommon but potentially life-threatening condition associated with significant maternal morbidity. Physiological adaptations of pregnancy, recent obstetric surgery, and overlapping postoperative symptoms frequently obscure early diagnosis and complicate perioperative and critical care management. This review provides a clinically oriented, anaesthesiology-focused overview of APIP, integrating current evidence with perioperative decision-making, pain management strategies, and intensive care considerations relevant to obstetric practice. Methods: A narrative, clinically structured review of the literature was performed focusing on epidemiology, aetiology, diagnosis, severity stratification, and management of APIP. Anaesthesiology- and ICU-specific aspects are synthesised into a pragmatic management framework. Results: Gallstone disease and hypertriglyceridaemia remain the predominant causes of APIP, with most cases occurring in the third trimester or early postpartum period. Diagnosis relies on pancreatic enzyme elevation and pregnancy-adapted imaging strategies. Early goal-directed fluid resuscitation, effective multimodal analgesia, and timely initiation of enteral nutrition are key determinants of outcome. Therapeutic ERCP and laparoscopic cholecystectomy can be safely performed during pregnancy when clinically indicated and may reduce recurrence in biliary pancreatitis. Neuraxial analgesia provides effective, opioid-sparing pain control and may improve respiratory mechanics and haemodynamic stability. Persistent organ failure remains the strongest predictor of adverse outcome and should prompt early intensive care admission. Conclusions: APIP requires early recognition and severity-adapted, multidisciplinary management. Anaesthesiology-led strategies play a central role in optimising analgesia, haemodynamic stability, and timely escalation of care. Framing APIP within a perioperative and critical care context may improve maternal outcomes in this vulnerable patient population.

Acute pancreatitis (AP) is one of the most common gastrointestinal emergencies, with more than 275,000 hospital admissions annually in the United States [2]. While most cases are mild, 15–20% progress to moderately severe or severe disease characterized by systemic inflammation, organ failure, and local complications [1,3]. Overall mortality remains 3–5%, but increases to 20–35% in patients with persistent organ failure requiring intensive care [7].Early assessment remains challenging. Traditional scoring systems (APACHE II, BISAP, Ranson, mCTSI) demonstrate modest accuracy within the first 24 hours [4,11]. Consequently, emerging biomarkers—including IL-6, IL-8, IL-10 [16–17], pentraxin-3 [8], sCD163 [7], NGAL [10], and presepsin—are critical for identifying early severity. Endothelial dysfunction markers including angiopoietin-2 [19], proADM, endocan, and VEGF provide additional predictive value by reflecting microcirculatory failure and shock. Oxidative stress markers such as MDA and GSH depletion correlate with necrosis and multi-organ dysfunction. ICU physiological predictors—vasopressor requirement, rising lactate, Horowitz-index deterioration, and early AKI—remain the strongest bedside indicators of poor outcome [18]. Modern management emphasizes goal-directed fluid therapy, controlled resuscitation with balanced crystalloids, and selective use of CRRT, although no multicenter RCT has yet confirmed its mortality benefit [20]. This review synthesizes classical and novel biomarkers, endothelial and oxidative markers, and ICU predictors to support a modern, precision-based approach to early risk assessment and managementin acute pancreatitis.