Gallbladder disease in pregnancy

To evaluate management and pregnancy outcomes in pregnant women with gallbladder disease.

We reviewed the records from three teaching hospitals in central North Carolina from 1986 to 1993 to evaluate women who were admitted with gallbladder disease during pregnancy.

Forty-two women were admitted with symptomatic cholelithiasis; 67% were white, the average age was 26 years, and the mean gestational age at presentation was 26 weeks. Conservative management with intravenous hydration, narcotics, dietary changes and antibiotics, if needed, was the first line of treatment in all 42 cases. Conservative management was successful in 17 women, with 8 requiring more than one admission. Nineteen patients failed medical management and needed cholecystectomy; three cases were laparoscopic. The diagnosis in the surgical group included 3 women with biliary colic, 14 with cholecystitis and 2 with gallstone pancreatitis. Four cholecystectomies were performed in the first trimester, 10 in the second and 5 in the third. Thirteen of 19 patients had no postoperative complications and delivered at term. Four women had uterine contractions controlled with tocolytics and delivered at 35 weeks or more. Two of 19 delivered prematurely--one at 32.5 weeks, 15 weeks after a laparoscopic cholecystectomy, and another at 34 weeks, 10 weeks after an open cholecystectomy. Of the patients who delivered prematurely, none were within the immediate postoperative period, and it appears unlikely that the cholecystectomy was causative. No maternal or perinatal mortality was noted.

This review and others indicate that surgery should be reconsidered as possible primary management in pregnant women with symptomatic gallbladder disease.