How Gallstones Are Treated During Pregnancy

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Gallstones are concentrated lumps of a substance called bile, which is made up of water, fat, cholesterol, bilirubin, and salts. It's normally released into your small intestine where it helps digest fats. However, bile can sometimes become concentrated and form "stones." Untreated gallstones can lead to infection or even a ruptured gallbladder.

In general, women are twice as likely as men to develop gallstones. During pregnancy, the odds are even higher. That's because the estrogen you produce during pregnancy can lead to higher cholesterol levels in your bile. As a result, about 5% to 8% of women will experience either gallbladder sludge or gallstones during pregnancy.

While it is more common to medically manage gallstones in pregnancy, gallstones are the second-most common cause of surgery during pregnancy that isn’t pregnancy-related. About one in 1,600 women will have their gallbladder taken out due to gallstones in pregnancy. Gallstones are more common in people who are obese, people who gain or lose weight rapidly, and in people who are not pregnant.

Symptoms of Gallstones

Gallstones can cause significant symptoms including:

  • Nausea
  • Vomiting
  • Sudden sharp pain in the upper right quadrant (which may move depending on the stage of pregnancy)
  • Fever

It is important to note that not all women will experience the above symptoms with gallstones during pregnancy. You may need to have testing done to figure out if your symptoms mean that you are, in fact, experiencing gallstones. Blood work may not be as useful in pregnancy due to normal pregnancy changes. Instead, ultrasound is used to detect many cases of gallstones during pregnancy.

How Gallstones Are Treated During Pregnancy

In looking at your symptoms and test results, your practitioner can recommend that you either have surgery to remove the gallstones or wait it out. Some doctors prefer to go ahead and operate because of the increased risk of a relapse, which can be worse. If you choose to wait it out, you can try to alter your diet and lower your intake of fried and fatty foods. You may also be given medications for the pain.

First Trimester Treatment

Surgery is generally not recommended in the first trimester except in extreme cases. This is because the risk of miscarriage is higher. There is also a greater risk of birth defects from exposing your baby to the medications needed to perform surgery.

If possible, surgery will be delayed until you have moved into the second trimester or until after you give birth.

Second Trimester Treatment

Surgery is safest in the second trimester. It is also the easiest time to do the procedure with laparoscopy as opposed to an open incision, which is more complicated and requires a longer healing time.

Third Trimester Treatment

If you're in your third trimester, it's possible your doctor will encourage you to try to wait it out rather than have surgery because your growing uterus makes it more difficult to perform surgery using the laparoscopic technique. It is also more likely that you could experience preterm labor in the third trimester. Your doctor may also recommend that you have your gallbladder removed in the postpartum period.

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Article Sources

  • Gabbe, S, Niebyl, J, Simpson, JL. Obstetrics: Normal and Problem Pregnancies Fifth Edition. 2017.

  • Mayo Clinic. Gallstones.