Objective: To investigate the management of severe acute pancreatitis (SAP) occurring in late pregnancy. Methods: The clinical data of 26 patients with SAP in late pregnancy treated during January 2001 to December 2011 were analyzed retrospectively. The average age of the patents was 26 (20–40) years, with average pregnancy period of 33 (29–39) weeks. Termination of pregnancy was performed by emergent cesarean section in patients carrying a full-term fetus with lung maturity. Those with preterm gestation initially underwent conservative treatments, and then were allowed to try to have a full-term delivery if SAP remitted, otherwise, they were subjected to a cesarean section combined with peripancreatic drainage. Results: Four patients of full-term pregnancy and one patient carrying a dead fetus underwent cesarean section immediately after admission, and then SAP in these cases remitted 1-5 d later. Of the 21 preterm pregnant patients, SAP remitted in 18 cases (85.7%) after 3–22 d of conservative treatment and their pregnancies were allowed to continue to go to full term, but conservative treatment failed in 3 cases (14.3%), of whom one case died of fulminant acute pancreatitis and 2 cases underwent pregnancy termination at 33 and 35 weeks of gestation respectively, and all the 3 fetuses died. Conclusion: Conservative treatment is effective in most women complicated with SAP during late pregnancy. Meanwhile, the conditions in both mother and fetus should be monitored closely, and once fetal visceral organs especially lung maturity has been achieved, or conservative treatments has failed, pregnancy termination should be performed.