From the Guidelines
Pregnancy can worsen gallbladder disorders, including cholelithiasis and cholecystitis, due to increased estrogen levels, and management should prioritize minimizing risks to the mother and fetus.
Effects of Pregnancy on Gallbladder Disorders
The effects of pregnancy on cholecystitis (inflammation of the gallbladder) and cholelithiasis (gallstones) are significant, with increased estrogen levels enhancing cholesterol secretion and reducing gallbladder contractility 1. Common conditions include:
- Cholelithiasis (gallstones)
- Cholecystitis (gallbladder inflammation)
- Biliary sludge
Management of Gallbladder Disorders During Pregnancy
Management typically begins with conservative approaches, including:
- Dietary modifications (low-fat diet, small frequent meals)
- Adequate hydration
- Pain control with acetaminophen (500-1000mg every 6 hours as needed, not exceeding 4g daily) For severe symptoms, hospitalization may be necessary with:
- IV hydration
- Bowel rest
- Parenteral nutrition if needed Antibiotics such as ceftriaxone (1-2g IV daily) plus metronidazole (500mg IV every 8 hours) are indicated for cholecystitis 1.
Surgical Intervention
Laparoscopic cholecystectomy is considered safe during pregnancy, with the second trimester being the ideal time for surgery, if absolutely necessary. ERCP may be performed for common bile duct obstruction with precautions to minimize radiation exposure 1. Regular prenatal care is essential as these conditions increase risks of preterm labor and other pregnancy complications. Patients should immediately report severe abdominal pain, fever, jaundice, or persistent vomiting to their healthcare provider.
Minimizing Radiation Exposure
To minimize fetal radiation exposure during ERCP, various measures should be taken, including:
- Using a modern fluoroscopy unit with collimation ability and pulsed fluoroscopy
- Using the last image hold feature and short taps of fluoroscopy
- Avoiding spot films and using magnification
- Using the bile aspiration technique, cholangioscopy, or endoscopic ultrasound to reduce radiation during cannulation and clearance during ERCP 1.
From the Research
Effects of Pregnancy on Cholecystitis and Cholelithiasis
- Pregnancy can increase the risk of developing cholelithiasis (gallstones) due to hormonal changes, particularly increased estrogen levels, which can induce significant metabolic changes in the hepatobiliary system 2.
- The incidence rates of biliary sludge and gallstones are up to 30% and 12%, respectively, during pregnancy and postpartum 2.
- Gallstones are more common in women than in men, and pregnancy further increases this risk, with epidemiological and clinical studies finding that gallstone prevalence is twice as high in women as in men at all ages 2.
Management of Cholecystitis and Cholelithiasis during Pregnancy
- The therapeutic approach for biliary disorders during pregnancy is generally conservative, with invasive procedures such as laparoscopic cholecystectomy being relatively well tolerated, preferably during the second trimester of pregnancy or postpartum 3, 2, 4.
- Endoscopic retrograde cholangiopancreatography (ERCP) can be safely performed during pregnancy for biliary stenting and subsequent clearance after delivery 5.
- Early laparoscopic cholecystectomy should be considered, especially in pregnant patients with acute pancreatitis due to gallstones in the first trimester 6.
Complications and Outcomes
- Pregnancy-related biliary sludge and gallstones tend to dissolve spontaneously after parturition in the majority of pregnant women 2, 4.
- However, in some situations, the conditions persist and require costly therapeutic interventions 2.
- Developments in supportive care, widespread use of imaging methods, and a multidisciplinary approach with better antenatal care of pregnant patients with acute pancreatitis can help prevent fetal and maternal morbidity and mortality 6.