Pregnancy and Cholelithiasis

  • Jaimey M. PauliEmail author


Pregnancy predisposes women to cholelithiasis due to the hormonal effects of estrogen and progesterone on cholesterol, soluble bile acid secretion, and gallbladder emptying. Gallstones cause biliary colic, acute cholecystitis, gallstone pancreatitis, choledocholithiasis, gallstone ileus, and cholangitis. Signs and symptoms include intermittent right upper quadrant pain, nausea, vomiting, epigastric pain, anorexia, intolerance of fatty foods, fever, elevated white blood cell count, elevated amylase and lipase, elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT), jaundice, and positive Murphy’s sign. Findings of cholecystitis on ultrasound are thickened gallbladder wall (>3–5 mm) or edema, presence of gallstones, pericholecystic fluid, and a sonographic Murphy’s sign. Cholecystectomy is clearly indicated for obstructive jaundice, acute cholecystitis failing medical therapy, gallstone pancreatitis, or suspected peritonitis. Conservative management has a 38% chance of suboptimal outcome, with a 34% risk of relapse, and increased severity of disease at relapse. The consideration for definitive surgical management of gallstone disease during pregnancy, especially in the first and second trimesters, is supported.


Gallstones Pregnancy Cholelithiasis Cholecystitis Gallstone pancreatitis Choledocholithiasis Gallstone ileus Cholangitis Murphy’s sign Cholecystectomy ERCP MRCP 


  1. 1.
    Gilo NB, Amini D, Landy HJ. Appendicitis and cholecystitis in pregnancy. Clin Obstet Gynecol. 2009;52(4):586–96.CrossRefGoogle Scholar
  2. 2.
    Williamson C, Mackillop L, Heneghan MA. Diseases of the liver, biliary system, and pancreas. In: Creasy and Resnik’s maternal fetal medicine: principles and practice. 7th ed. Philadelphia: Elsiever; 2014.Google Scholar
  3. 3.
    Date RS, Kaushal M, Ramesh A. A review of the management of gallstone disease and its complications in pregnancy. Am J Surg. 2008;196(4):599–608.CrossRefGoogle Scholar
  4. 4.
    Sharp HT. The acute abdomen during pregnancy. Clin Obstet Gynecol. 2002;45(2):405–13.CrossRefGoogle Scholar
  5. 5.
    Diegelmann L. Nonobstetric abdominal pain and surgical emergencies in pregnancy. Emerg Med Clin N Am. 2012;30:885–901.CrossRefGoogle Scholar
  6. 6.
    Lu EK, Curet MJ, El-Sayed YY, Kirkwood KS. Medical versus surgical management of biliary tract disease in pregnancy. Am J Surg. 2004;188:755–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Maternal-Fetal Medicine, Department of Obstetrics and GynecologyPenn State Health Milton S. Hershey Medical CenterHersheyUSA

Personalised recommendations