MTP2.13 Acute pancreatitis in the peri-partum population: a convoluted referral pathway? Service review from the emergency general surgery service in a tertiary centre

Introduction Acute pancreatitis is more common in the peri-partum period, and is associated with adverse maternal/ foetal outcomes. Primarily caused by gallstones, which are often symptomatic prior to the onset of pancreatitis. Due to complex presentation, non-obstetric abdominal pain (NAP) presenting in the intrapartum period should prompt early referral to emergency general surgery services. Methods Review of case-notes of female patients aged 16-45, admitted with confirmed pancreatitis between October 2022-2024. Patients admitted pregnant or within 2 years of delivery were included. Results 25 patients (median age 30.8; range 23.0-43.9 years), 87.5 days post-partum (-65 to 525 days) had confirmed pancreatitis. 2/25 (8%) had pancreatitis during pregnancy and 23/25 (92%) within two years post-partum. 4/25 (16%) had no previous presentations with NAP. 11/25 (44%) had previously presented to hospital services at least once with NAP prior to referral:6 (54.5%) initially presented to obstetric services. One of these was seen once by obstetrics during pregnancy for epigastric pain, and twice more in ED prior to referral.4 (36.4%) had presented to emergency department.1 (9.1%) patient referred on non-urgent ultrasound pathway by primary care. Notably, 16/25 (64%) patients had other established risk factors (obesity, Crohn’s’ disease, diabetes mellitus) for pancreatitis. Of the 23 postpartum pancreatitis admissions, 17/23 (73.9%) were not breastfeeding. Conclusion Our experience suggests the need for a streamlined referral pathway for peri-partum patients, particularly those with risk factors for acute pancreatitis. Efficient referral generates opportunity for prompt management of gallstones thereby preventing complications such as acute pancreatitis.