The incidence of acute pancreatitis caused by hyperlipidemia can occur at any stage of pregnancy, but it is most common in late pregnancy and relatively rare in early and mid-pregnancy, and the onset of puerperium is easily misdiagnosed and missed. The literature reports that the incidence of acute pancreatitis in pregnancy and puerperium is about 0.01%-0.1%, and 19%, 26%, 53% and 2.0% in early, middle and late pregnancy and postpartum, respectively. The clinical characteristics of acute pancreatitis in different gestational periods vary, and the disease and pregnancy interact, which makes diagnosis and treatment difficult, especially acute pancreatitis in pregnancy caused by hyperlipidemia, and the literature reports that the fetal mortality rate is close to 10-20%, which is a serious threat to the life of the mother and child. 1, the pathogenesis of hyperlipidemic pancreatitis in pregnancy Hyperlipidemia is one of the causes of acute pancreatitis, an epidemiological data from mainland China shows that the acute pancreatitis caused by it accounts for 8.3% of the total causes of pancreatitis. During pregnancy, changes in the levels of various hormones such as estrogen, progesterone, chorionic gonadotropin, prolactin and insulin have different degrees of influence on the body’s material metabolism, especially elevating serum triglycerides, which increase by about 30% in women after pregnancy, reaching a peak in the second trimester and decreasing rapidly after delivery. The pancreatitis caused by hyperlipidemia accounted for more than 50% of pancreatitis in pregnancy. It has been shown that serum cholesterol, free fatty acids, triglycerides and low-density lipoproteins are significantly elevated in late pregnancy, with triglycerides being up to seven times the normal value. Triglycerides are broken down by placental prolactin in the pancreas during pregnancy, releasing large amounts of free fatty acids, which can be highly toxic to capillaries and pancreatic vesicle cells. Pregnancy-related comorbidities can also be the initiating factor or aggravating factor of acute pancreatitis. During pregnancy, the increase in intra-abdominal pressure due to the enlarged uterus, pregnancy and breath-holding factors will adversely affect the microcirculation of the pancreas; the endocrine effects of pregnancy can increase the secretion of pancreatic vesicles; the increase in serum parathyroid hormone levels can lead to hypercalcemia and stimulate the secretion of pancreatic enzymes; the high level of neurological tension during pregnancy can trigger spasm of the sphincter of Oddis, which can increase the pressure in the pancreatic duct or bile reflux and lead to acute The occurrence of acute pancreatitis. The clinical characteristics and diagnosis of hyperlipidemic pancreatitis in pregnancy The abdominal pain of acute pancreatitis in pregnancy is usually located in the middle and upper abdomen, and the pain often radiates to the left shoulder or waist and back in a girdle pattern. It is often accompanied by abdominal distension, nausea, vomiting and other gastrointestinal symptoms. In early pregnancy, it is especially important to differentiate it from early pregnancy reaction to avoid delaying the diagnosis. Signs of acute pancreatitis in pregnancy are often inconsistent with severe abdominal pain, especially in late pregnancy, when they may be less obvious due to the enlarged uterus and the upward pushing gastrointestinal and greater omentum obscuration. The determination of serum amylase and lipase is important to confirm the diagnosis of pregnancy combined with acute pancreatitis, serum amylase is usually elevated 2 h after onset, peaking at 12-24 h and lasting 4-5 d. Urinary amylase is also elevated; in some patients, serum amylase and lipase are not elevated, but imaging has evidence of pancreatic edema, necrosis or peripancreatic fluid, so the diagnosis of acute pancreatitis cannot be easily dismissed because blood and urinary amylase are normal. Therefore, the diagnosis of acute pancreatitis cannot be easily rejected because of normal blood and urine amylase. In acute pancreatitis due to hyperlipidemia, peripheral blood is often seen to be celiac, and serum cholesterol, triglycerides and lipoproteins are significantly elevated. Ultrasonography is the preferred diagnostic method for acute pancreatitis in pregnancy because of its non-invasive nature. It can observe the outline of the pancreas, whether it is enlarged, whether the internal echogenicity is uniform, whether there is exudation around it, whether there is fluid in the abdominal cavity, etc. It can also observe the condition of the fetus. CT examination can clearly show the outline of the pancreas, whether there is fluid around the pancreas and abdominal cavity, etc., which is of great value for the diagnosis of acute pancreatitis. However, its effect on the fetus is controversial, especially in early pregnancy. The International Society for Radiation Protection believes that exposure to radiation below 5 cGy has a lower teratogenic risk compared to other teratogenic factors during pregnancy. Therefore, it is safe to receive a single CT examination, at least for patients in the middle and late stages of pregnancy. Treatment of hyperlipidemic pancreatitis in pregnancy In principle, the treatment of hyperlipidemic pancreatitis in pregnancy is basically the same as that of hyperlipidemic pancreatitis in non-pregnancy, but because of the need to take into account the safety of the mother and the baby, it is often necessary to combine multiple disciplines such as surgery, obstetrics and gynecology, pediatrics and critical care medicine to develop an individualized treatment plan based on the patient’s condition and the growth of the fetus. (1) Non-surgical treatment For patients with mild disease in the early stages, non-surgical treatment is available; the basic measures are similar to those for non-pregnant patients. It is worth reminding that there is no sufficient evidence of growth inhibitors to improve the prognosis of acute pancreatitis, and these drugs have an effect on fetal development, so the author believes that they should not be used routinely. Since the patient is fasting, reasonable nutritional support is necessary, but fat intake should be limited. Plasma exchange can rapidly lower lipid levels and bring about significant improvement in the patient’s condition, but in some patients, lipid levels can be quickly reduced to normal even after fasting and limiting fat intake, so plasma exchange is not necessary for every patient. (2) Surgery For patients whose conservative treatment is ineffective, invasive methods should be used decisively; because hyperlipidemic pancreatitis is rarely combined with biliary obstruction, the main purpose of surgery is to remove necrotic tissue and drain the abdominal cavity; when necrosis is not serious and there is more fluid in the abdominal cavity, percutaneous puncture under B ultrasound guidance can be used to place a multi-point tube for drainage, or a small incision can be made through the abdominal wall under B ultrasound guidance to place a tube for drainage; when necrotic When there is more necrotic tissue, laparoscopic or open removal and drainage of necrotic tissue can be performed. (3) Management of pregnancy Although termination of pregnancy can help to safely apply a series of tests and treatments, which is beneficial to the remission of acute pancreatitis, termination of pregnancy should not be considered as a treatment for pancreatitis. Whether to terminate pregnancy requires comprehensive consideration of the maternal condition, fetal development, and fetal survival [7]. Cytokines and inflammatory mediators produced by acute pancreatitis may affect fetal growth and development through the placenta; ARDS due to acute pancreatitis may, in turn, lead to intrauterine distress and even intrauterine death of the fetus. Therefore, for patients in late pregnancy, if the possibility of fetal survival after birth is considered high after multidisciplinary assessment, the pregnancy should be decisively terminated. Patients in the early and middle stages of pregnancy should be monitored more closely and early measures should be taken to expel the stillborn fetus if fetal death is detected. The general principle is to take into account the safety of the mother and child as much as possible, and when this is not possible, the primary goal in the decision-making process of pregnancy termination should be to preserve the life of the pregnant woman. In conclusion, although the incidence of hyperlipidemic pancreatitis in pregnancy is low, once it occurs, it may threaten the life of mother and child. Therefore, mothers should adopt reasonable and balanced nutrition during pregnancy to avoid hyperlipidemia, and once it occurs, a clear diagnosis should be made as soon as possible, and multidisciplinary collaboration should be used to develop an “individualized” treatment plan to reduce the morbidity and mortality of this disease.