Acute hyperlipidemic pancreatitis in pregnancy.

BACKGROUND: Pancreatitis in pregnancy remains a rare event and is most often associated with gallstone disease. Hyperlipidemic gestational pancreatitis usually occurs in women with a preexisting abnormality of the lipid metabolism and poses particular problems in diagnosis and clinical management. CASES: We describe 5 patients with acute episodes of pancreatitis during pregnancy caused by hyperlipidemia. CONCLUSION: Acute pancreatitis in pregnancy causes significant morbidity. Even though it is often associated with gallstones, we describe 5 cases in which the etiology of the pancreatitis was maternal hyperlipidemia. Etiology, diagnosis, and management will be discussed.

Management of ectopic pregnancy in the military during deployment to Southwest Asia.

BACKGROUND: Expeditionary military facilities care for deployed military personnel. They deploy with limited equipment and personnel to austere environments. Female military personnel are deployed forward in a support capacity. Under these conditions, ectopic pregnancy continues to be a potential catastrophe leading to maternal death. CASES: We report three cases of ectopic pregnancy in forward-deployed personnel. The random occurrence and different clinical presentations emphasize the importance of early diagnosis and management. CONCLUSION: During austere remote deployments, early diagnosis and evacuation of patients with ectopic pregnancy may make the difference between excellent outcomes and maternal death.

Commitment, confirmation, and clearance: new techniques for nonradiation ERCP during pregnancy (with videos).

BACKGROUND: Symptomatic choledocholithiasis during pregnancy can be treated with ERCP, but fluoroscopy may pose a risk to the fetus. Nonradiation ERCP may be a safer form of treatment, but its performance has not been optimized. OBJECTIVES: The purpose of this study was to evaluate new methods of nonradiation ERCP during pregnancy, including wire-guided cannulation techniques to achieve bile-duct access without the use of fluoroscopy, and the use of peroral choledochoscopy to confirm ductal clearance. STUDY DESIGN: A retrospective review of consecutive ERCPs performed on pregnant women. SETTING: Urban referral hospital. PATIENTS: Pregnant women with symptomatic choledocholithiasis. INTERVENTIONS: All patients underwent therapeutic ERCP without any use of fluoroscopy. Endoscopist-controlled wire-guided cannulation was performed to achieve biliary access. MAIN OUTCOME MEASUREMENTS: The rate of successful biliary cannulation and short-term outcomes. LIMITATIONS: ERCP procedures were performed by a single endoscopist. RESULTS: Successful bile-duct cannulation with sphincterotomy and the removal of biliary stones or sludge was performed without fluoroscopy in 21 pregnant women. There was one case of mild post-ERCP pancreatitis. Choledochoscopy confirmed ductal clearance in 5 cases. CONCLUSIONS: Nonradiation ERCP is a safe and effective treatment for symptomatic choledocholithiasis during pregnancy. Wire-guided biliary cannulation and choledochoscopy may enhance the performance of ERCP in this setting.

Maternal mortality in the U.S. Department of Defense, 1993-1998.

OBJECTIVE: To determine the maternal mortality ratio (MMR) in Department of Defense medical facilities from 1993 to 1998. STUDY DESIGN: We conducted a retrospective review of birth data from military medical facilities using the Standard Inpatient Data Records from 1993 through 1998. The total number of live births and dispositions due to maternal death were obtained. RESULTS: Twenty-two maternal deaths occurred in the study time out of 398,107 live births, for an MMR of 5.5 per 100,000 live births. The ratiosfor the service branches were: Army 7.0, Navy 5.3 and Air Force 3.6. The leading cause of death was embolic disease. CONCLUSION: The military MMR is closer to the Healthy People 2010 goal of 3.3 than is the national ratio, 13.2. Improved reporting of cases, patient education and treating high-risk conditions may help further decrease pregnancy-related mortality.