Why are pregnant women more likely to develop gallstones. What are the symptoms of gallstones during pregnancy. How can pregnant women prevent gallstone formation. What complications can arise from gallstones in pregnancy. When should pregnant women seek medical attention for gallstone symptoms. How does pregnancy increase the risk of gallstone development. What dietary changes can help prevent gallstones in pregnancy.

The Link Between Pregnancy and Gallstone Formation

Pregnancy significantly increases a woman’s risk of developing gallstones. While women are generally 2-3 times more likely than men to experience gallstones, pregnancy further elevates this risk. The primary culprit behind this increased susceptibility is the surge in estrogen levels that occurs during pregnancy.

Elevated estrogen causes a rise in cholesterol levels, which can lead to an imbalance in the composition of bile. Bile, produced by the liver and stored in the gallbladder, plays a crucial role in fat digestion. When the balance of bile components is disrupted, it can result in the formation of gallstones.

How does estrogen contribute to gallstone formation?

Estrogen increases cholesterol secretion into bile and reduces bile acid synthesis. This alteration in bile composition creates an environment conducive to gallstone formation. Additionally, pregnancy hormones can slow gallbladder contractions, leading to bile stasis and further increasing the risk of stone formation.

Understanding the Gallbladder’s Function and Bile Composition

The gallbladder is a small organ that plays a vital role in the digestive process. Its primary function is to store and concentrate bile produced by the liver. When we consume fatty foods, the gallbladder contracts and releases bile into the small intestine to aid in fat digestion.

Bile is composed of three main components:

• Cholesterol
• Bilirubin
• Bile salts

A delicate balance of these components is essential for proper bile function. When this balance is disrupted, such as during pregnancy, it can lead to the formation of gallstones.

What happens when bile composition is imbalanced?

An excess of cholesterol or bilirubin, coupled with insufficient bile salts, can cause these substances to crystallize and form gallstones. These stones can vary in size from tiny grains to larger, golf ball-sized masses.

Recognizing Gallstone Symptoms During Pregnancy

While some women with gallstones may remain asymptomatic, others can experience severe discomfort. It’s crucial for pregnant women to be aware of potential gallstone symptoms to seek timely medical attention.

Common symptoms of gallstones during pregnancy include:

• Severe and persistent pain in the upper right abdomen, especially after fatty meals
• Pain that radiates to the right shoulder or back
• Nausea and vomiting
• Fever and chills
• Jaundice (yellowing of the skin and eyes)
• Dark urine
• Clay-colored stools
• Intense itching

When should pregnant women seek medical attention for gallstone symptoms?

If you experience severe abdominal pain lasting more than five hours, accompanied by any combination of the above symptoms, it’s crucial to seek immediate medical attention. Prompt treatment can prevent serious complications and ensure the health of both mother and baby.

Potential Complications of Gallstones in Pregnancy

Untreated gallstones can lead to several complications during pregnancy, some of which can be severe. Understanding these potential risks underscores the importance of prevention and timely treatment.

What is cholestasis of pregnancy?

Cholestasis of pregnancy is a liver condition that can develop due to gallstones. It occurs when bile flow is slowed or blocked, leading to a buildup of bile acids in the blood. This condition can cause intense itching and, in severe cases, may pose risks to the developing fetus.

Other potential complications of gallstones during pregnancy include:

• Cholecystitis (inflammation of the gallbladder)
• Pancreatitis
• Biliary tract obstruction
• Gallbladder rupture (in rare cases)

These complications can lead to preterm labor, fetal distress, and other pregnancy-related complications. Therefore, prompt diagnosis and appropriate management of gallstones are crucial during pregnancy.

Preventing Gallstones During Pregnancy

While the risk of gallstones increases during pregnancy, there are several steps women can take to reduce their likelihood of developing these painful stones.

How can dietary changes help prevent gallstones?

Adopting a healthy, balanced diet is one of the most effective ways to prevent gallstone formation. Consider the following dietary recommendations:

1. Increase fiber intake: Consume plenty of fruits, vegetables, and whole grains.
2. Choose healthy fats: Focus on monounsaturated fats and omega-3 fatty acids found in foods like olive oil, avocados, and fatty fish.
3. Limit saturated fats: Reduce consumption of red meats, full-fat dairy products, and fried foods.
4. Reduce sugar and refined carbohydrates: Cut back on sugary foods and white flour products like pasta, crackers, and white bread.

Is weight management important in preventing gallstones?

Yes, maintaining a healthy weight during pregnancy is crucial in preventing gallstones. Obesity increases the risk of gallstone formation, so it’s important to gain weight within the recommended range for your pregnancy. Consult with your obstetrician to develop a personalized strategy for healthy weight gain.

Diagnosis and Treatment of Gallstones During Pregnancy

If gallstones are suspected during pregnancy, healthcare providers will typically use ultrasound imaging to confirm the diagnosis. This non-invasive technique is safe for both mother and baby.

How are gallstones treated during pregnancy?

Treatment options for gallstones during pregnancy depend on the severity of symptoms and the stage of pregnancy. In many cases, conservative management is preferred, focusing on dietary modifications and pain management. However, in severe cases or when complications arise, surgical intervention may be necessary.

Treatment approaches may include:

• Dietary modifications to reduce fat intake
• Pain management with safe medications
• Ursodeoxycholic acid to dissolve small stones (in select cases)
• Laparoscopic cholecystectomy (gallbladder removal) if necessary, typically performed during the second trimester

The decision to pursue surgical treatment is made on a case-by-case basis, weighing the risks and benefits for both mother and baby.

Long-term Considerations and Postpartum Care

Women who develop gallstones during pregnancy may continue to be at risk for gallstone-related issues after delivery. It’s important to maintain healthy lifestyle habits and follow up with healthcare providers postpartum.

Do gallstones always require treatment after pregnancy?

Not necessarily. Some women may experience resolution of their gallstone symptoms after delivery as hormone levels stabilize. However, others may continue to have issues and require treatment. Regular follow-ups with a healthcare provider can help determine the best course of action.

Postpartum considerations for women with a history of gallstones include:

• Continued dietary modifications to support gallbladder health
• Monitoring for recurrent symptoms
• Discussion of treatment options if symptoms persist or worsen
• Consideration of preventive measures for future pregnancies

The Importance of Prenatal Care and Open Communication

Regular prenatal check-ups play a crucial role in monitoring for potential gallstone development and other pregnancy-related complications. Open communication with healthcare providers is essential for early detection and management of gallstones.

How can pregnant women advocate for their gallbladder health?

To ensure optimal gallbladder health during pregnancy, consider the following steps:

1. Discuss your risk factors for gallstones with your healthcare provider
2. Report any symptoms promptly, no matter how mild they may seem
3. Ask about appropriate dietary guidelines and weight gain recommendations
4. Follow through with recommended screenings and tests
5. Seek a second opinion if you have concerns about your care or treatment plan

By staying informed and proactive, pregnant women can take control of their gallbladder health and reduce the risk of complications associated with gallstones during pregnancy.

Why Are Pregnant Women More Likely to Get Gallstones?

There is a clear correlation between gallstones and pregnancy. If you are a woman, you are 2 – 3 times more likely to have gallstones than men.

In addition, if you are pregnant, you increase that risk even more due to the elevation of estrogen that occurs during pregnancy. Higher levels of estrogen causes a rise in cholesterol which leads to the development of gallstones.

It is important for you to know the symptoms of gallstones so you can recognize when to seek care before this condition becomes a medical emergency.

Functions of the Gallbladder

This tiny storage organ can cause all kinds of complications while you are pregnant. The gallbladder stores bile produced by the liver with the sole purpose of releasing it into the small intestine when our body needs it. This release helps us to digest fat and dairy.

Bile is comprised of cholesterol, bilirubin, and bile salts. If the makeup of bile is not balanced properly, it can create stones and the slowing of gallbladder contractions. For example, too much cholesterol, or too much bilirubin and not enough bile salts can develop gallstones.

Symptoms and Complications of Gallstones During Pregnancy

Not everyone experiences symptoms with gallstones, but if you do, they can be quite serious. The following occurrences are all signs of a gallstone:

• Severe and continuous pain in the upper right part of the abdomen especially after a fatty meal
• Intense itching
• Pain in the upper abdomen which moves into the right shoulder and back
• Severe abdominal pain lasting more than five hours
• Nausea and vomiting
• Fever and chills may be present
• Yellowing of the skin and whites of the eyes
• Dark urine
• Clay colored stools

Seek immediate medical attention with any combination of these symptoms. Gallstones cause inflammation and can develop into cholestasis of pregnancy, and the slowing of gallbladder contractions. This most often occurs due to an insufficient amount of bile release.

Excess hormone production is another common contributor to gallstones. Having too much estrogen in the body increases the amount of cholesterol in our bile, which then begins to trigger cholestasis of pregnancy and additional complications.

How You Can Prevent Gallstones

It is possible to prevent gallstones by controlling the amount of cholesterol in your diet and the amount of weight you gain. Obesity increases your risk to develop gallstones.

Consult with your obstetrician to develop a strategy on the avoidance of excess weight.

Eat lots of high fiber foods and the right fats. Concentrate on monounsaturated fats and omega 3 fats to help prevent stones from forming. Avoid high saturated fats like red meats, dairy, and fried foods.

Cut back on sugar and white flour like pasta, crackers, bread, and chips.

Managing diabetes is essential during pregnancy. Not only will monitoring this condition help reduce your risk for gallstones, but it also provides a wealth of other opportunities in regards to your overall health.

Final Thoughts

It is hard to give up all the foods you crave during pregnancy. Who doesn’t want a juicy cheeseburger, or to sit with a bag of chips at night? Sadly, neither of these choices possess much benefit to you or your little one. Stay focused during this special time by lowering cholesterol intake and preventing gallstones.

See your obstetrician right away if you suspect you may have gallstones, as these are always better to be treated sooner rather than later. To contact a provider at Dedicated to Women OBGYN, please call (302) 674-0223.

Symptoms, Diagnosis, Treatment and Prevention

On top of morning sickness, stretch marks, and swollen feet, pregnant women have yet another thing to worry about: gallstones. But despite the increased risk, there are things you can do to help prevent this unwanted side effect of pregnancy.

Gallstones can lead to pain and other symptoms, and if left untreated, they can cause your gallbladder to become infected or even rupture. Women have a 2 to 3 times higher rate of gallstones than men, and hormonal changes that occur during pregnancy put them at even greater risk. Still, gallstones are not an inevitable part of pregnancy if you’re willing to take steps to help avoid them.

What’s the Link Between Pregnancy and Gallstones?

Bile is a liquid produced by your liver that is primarily made of cholesterol, bilirubin, and bile salts. Your gallbladder stores bile until your body needs it, and then releases it into your small intestine, where it helps with the digestion of dietary fat and fat-soluble vitamins. If the substances that make up your bile become imbalanced — too much cholesterol or bilirubin and not enough bile salts, for example — hardened gallstones may form in your gallbladder.

“Pregnant women are at increased risk for gallstones because of increased estrogen levels,” says Jose Nieto, DO, a gastroenterologist at the Borland-Groover Clinic in Jacksonville, Florida, adding that weight gain and rapid weight loss after pregnancy also increase the risk. Increased estrogen is problematic because it can cause cholesterol levels in bile to spike, which can lead to the development of gallstones.

Women who take birth control pills or are on hormone replacement therapy are also at increased risk of developing gallstones since these contain estrogen.

Symptoms of Gallstones During Pregnancy

Sometimes gallstones don’t cause problems or symptoms, and they may go away on their own after you deliver your baby. But it’s important to tell your doctor if you’re having any of the following potential symptoms of gallbladder problems:

• Steady, severe pain in the upper right portion of your abdomen, especially after eating a fatty meal
• Pain in the upper abdomen that radiates into your right shoulder and back
• Abdominal pain that lasts more than five hours
• Nausea and vomiting
• Fever or chills
• Yellowing skin or whites of the eyes (jaundice)
• Stools that are clay colored

Diagnosis and Treatment of Gallstones During Pregnancy

To confirm a diagnosis of gallstones, your doctor may perform an abdominal ultrasound, much like those you’ve probably already had to see your developing baby.

Make sure your doctor knows that you’re pregnant, since many diagnostic tests for gallstones, such as an oral cholecystogram (X-ray of the gallbladder), computerized tomography (CT) scan, or nuclear scan may not be safe during pregnancy.

Gallstones are most commonly treated by cholecystectomy, which is the surgical removal of your gallbladder. Depending on your symptoms and risk factors, your doctor may choose to carefully monitor you during pregnancy or go ahead and remove your gallbladder while you are pregnant.

How To Prevent Gallstones During Pregnancy

Here’s what you can do to help lower your risk of gallstones during pregnancy:

• Gain a healthy amount of weight. Obesity is a major risk factor for the development of gallstones in women. Pregnancy is not a time for weight-loss diets, but working with your doctor to avoid excess weight gain can help.
• Eat a high-fiber diet. Too little fiber can increase your risk of developing gallstones. Eating more fiber-rich foods can help keep your gallbladder — and your baby — healthy.
• Choose the right fats. Monounsaturated fats and omega-3 fats help prevent gallstones, while foods high in saturated fat tend to promote their formation.
• Cut back on sugar and other refined carbohydrates. Sugar and products made from white or refined flour — such as many types of bread, pasta, crackers, and chips — increase the risk of gallstones. They also provide mostly empty calories, which is not something you or your baby really need.
• Manage diabetes. People with diabetes often have high triglyceride levels, and both conditions have been linked to an increased risk of gallstones. So work with your doctor to keep your diabetes under control while you are pregnant.

Avoiding gallstones during pregnancy may just take some small tweaks to your routine. But talk to your doctor if you are at higher risk for gallstones, or are developing any worrisome symptoms during your pregnancy.

Additional reporting by Erica Ilton, RDN.

What Are Common Gallbladder Problems? Symptoms, Causes, Diagnosis, Treatment, and Prevention

The gallbladder stores bile, which helps the body break down and digest fats that you eat. Disorders like gallstones can cause problems with how the gallbladder…

By Quinn PhillipsJanuary 4, 2023

Gallbladder Surgery Complications

Like any surgery, gallbladder removal comes with a risk of certain complications. These include bile leakage, blood clots, and potential digestive changes…

By Quinn PhillipsDecember 7, 2022

Gallstones and Other Gallbladder Problems

Gallstones occur when one or more of the substances that make up the bile becomes too concentrated and forms a hard stone. Other gallbladder problems …

By Diana RodriguezNovember 19, 2022

What Is Cholecystitis?

Cholecystitis, or inflammation of the gallbladder, often occurs when a gallstone blocks a duct in the gallbladder.

By Diana RodriguezNovember 14, 2022

Your Diet After Gallbladder Surgery

Some people need to maintain a modified diet after gallbladder surgery. Follow this diet for effective gallbladder surgery recovery.

By Krisha McCoyOctober 17, 2022

Symptoms of a Gallbladder Problem

Symptoms of gallbladder problems may include severe abdominal pain, especially after you eat fatty foods.

By Diana RodriguezSeptember 30, 2022

Gallbladder Surgery: What to Expect

If you’re having gallbladder symptoms caused by gallstones or other conditions, your doctor may recommend gallbladder surgery.

By Jennifer Acosta ScottSeptember 8, 2022

4 Ways to Prevent Gallstones

There is no sure way to prevent gallstones, but there are things you can do to reduce your risk. Get tips on gallstone prevention.

By Hedy MarksDecember 3, 2018

The Link Between Gallbladder Problems and Diabetes

Controlling diabetes is vital for many reasons, including avoiding gallbladder problems. Learn how to lower your risk of gallstones.

By Diane StresingMay 1, 2018

Gallstone disease in pregnant women. What is gallstone disease in pregnancy?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Gallstone disease in pregnancy is a pathological condition with the formation of stones in the gallbladder that occurred before conception, during pregnancy or after childbirth. In half of the cases proceeds without clinical symptoms. It can be manifested by bouts of severe pain in the right hypochondrium, nausea, vomiting, bloating, bitterness in the mouth, heartburn, yellowness of the skin and mucous membranes. Diagnosed on the basis of data from abdominal ultrasound, duodenal sounding, biochemical blood tests. For treatment, choleretic agents, cholekinetics, antispasmodics, antibacterial drugs are used. If indicated, cholecystectomy is performed.

ICD-10

K80 Cholelithiasis [cholelithiasis]

• Causes
• Pathogenesis
• Classification
• Symptoms of gallstone disease in pregnancy
• Complications
• Diagnostics
• Treatment of cholelithiasis in pregnant women
• Prognosis and prevention
• Prices for treatment

General

One of the traditional risk factors for gallstone disease (GSD, cholelithiasis) is gender. Most researchers in the field of modern gastroenterology, obstetrics and gynecology consider the changes that occur in the bile secretion system during gestation to be the key cause of the onset of the disease in patients of reproductive age. According to statistics, up to 6.5-8.3% of nulliparous women suffer from cholelithiasis.

Among patients who had 2 or more pregnancies, the prevalence of gallstone pathology is almost three times higher and reaches 18.4-19.3%. Biliary sludge is first diagnosed in 15-30% of pregnant women, calculi – in 2-8% of women before childbirth and in 10% – at 4-6 weeks of the postpartum period. The frequency of cholecystectomy during gestation is 0.1-3%. The increased risk of cholelithiasis persists for 5 years after delivery, with 0.8% of patients having their gallbladder removed.

Gallstone disease in pregnant women

Causes

In the development of gallstone disease in pregnant women, as well as outside the gestation period, a certain role is played by genetic predisposition, including hereditary and dysembryogenic anomalies in the development of the biliary system, irregular nutrition with the use of a large amount of sweets and animal fats, overweight, diseases of the duodenum, worsening bile passage. Specialists in the field of obstetrics have identified a number of specific factors that contribute to the occurrence of gallstone disease in pregnant women. The main ones are:

• Increased lithogenicity of bile. Under the influence of estrogen, the concentration of which gradually increases during pregnancy, the level of cholesterol in bile increases. Estrogens also inhibit the synthesis of chenodeoxycholic acid, which contributes to the precipitation of cholesterol crystals and the formation of biliary sludge – a suspension of insoluble components of bile.
• Violation of motility of the biliary tract. Against the background of progesterone-induced relaxation of smooth muscle fibers, the contractile function of the gallbladder decreases, and its emptying slows down. As a result, already from the first trimester, bile stasis occurs in pregnant women, which is manifested by an increase in the fasting and residual volume of the organ by 30%, which increases the risk of stone formation.
• Mechanical displacement of the gallbladder. Under the pressure of the uterus, the anatomical arrangement of the organs of the upper part of the abdominal cavity changes, which are pressed against the diaphragm and partially squeezed. Pressure on the neck of the gallbladder, cystic and common ducts disrupts the evacuation of bile, provokes its stagnation and precipitation of cholesterol crystals.
• Change in diet. An increase in the calorie intake of pregnant women, especially when eating foods rich in carbohydrates and cholesterol, is accompanied by weight gain with an increase in adipose tissue and an increase in insulin resistance. This leads to even greater saturation of bile with cholesterol and a decrease in the total pool of bile acids, disrupts the motility of the bile excretion organs.

Previously, physical inactivity was traditionally considered one of the factors that increase the risk of gallstone disease during pregnancy. However, recent studies show that with increased physical activity, the incidence of biliary sludge and cholesterol stones does not decrease, and metabolic parameters (lipids, adiponectin, insulin, glucose, leptin) do not improve.

Pathogenesis

The mechanism of development of cholelithiasis in pregnant women is associated with the action of two independent factors – an increase in the concentration of lithogenic cholesterol in bile and its stagnation. Other factors also play a role in maintaining a stable colloidal state of gallbladder bile – its saturation with lecithin, bile acids, etc. An imbalance of the main components of the contents of the gallbladder, characteristic of pregnant women, against the background of slowing down the emptying of the organ, contributes to cholesterol nucleation, precipitation of microcrystals and further growth of stones. An additional link in the pathogenesis of cholelithiasis is a compensatory increase in water reabsorption and, as a result, a further increase in the concentration of bile.

Classification

The systematization of clinical forms of cholelithiasis takes into account the characteristics of the course of the disease, the severity of symptoms, the presence or absence of complications. The correct definition of the cholelithiasis variant plays a decisive role in predicting the outcome of gestation, choosing the tactics of managing a pregnant patient and the optimal method of delivery. There are the following types of gallstone disease:

• Asymptomatic cholelithiasis. Stones are found in the cavity of the gallbladder, but there are no clinical symptoms. The most favorable option, in which for the normal course of gestation it is enough to adjust the diet.
• Uncomplicated cholecystitis. Depending on the morphological features and nature of the changes, cholecystitis can be catarrhal and destructive (phlegmonous, gangrenous), acalculous and calculous, primary and aggravated recurrent.
• Complicated cholecystitis. Inflammation of the gallbladder can be complicated by obstruction (occlusion) of the ducts, perforation with the development of a clinic of local or diffuse peritonitis, perforated peritonitis, lesions of the bile ducts and combined pancreatitis.

Domestic gastroenterologists distinguish several stages of gallstone disease. At the I (initial, prestone) stage, biliary sludge is formed from thick heterogeneous bile. Stone formation indicates the transition of the disease to stage II. Stones can be single and multiple, cholesterol, pigmented and mixed, localized inside the gallbladder, hepatic or common ducts. At this stage, cholelithiasis is latent, painful with characteristic colic, dyspeptic, atypical, mimicking other diseases. Stage III is characterized by a recurrent course of calculous cholecystitis, for stage IV – the occurrence of complications. In pregnant women, the disease is more often detected in stages I and II, less often in stages III.

Symptoms of gallstone disease in pregnancy

In more than half of the patients, cholelithiasis is asymptomatic and becomes an incidental finding during an ultrasound examination of the abdominal organs performed for other indications. In 45% of cases, cholelithiasis that existed before gestation worsens and manifests clinically. With latent painless progression of the disorder, a pregnant woman may periodically experience heaviness in the right hypochondrium, heartburn, a taste of bitterness in the mouth, note the changed nature of the stool – a tendency to constipation or relaxation, which are usually regarded by the patient as early toxicosis.

In some women, the disease is manifested by transient jaundice with icterus of the skin, sclera, mucous membranes, short-term darkening of the urine and discoloration of the feces. The most characteristic symptom of the pathology is an attack of biliary colic, which occurs in 88% of pregnant women with a manifest course. During colic, the patient feels intense pain in the epigastrium and right hypochondrium, which radiates to the right shoulder, shoulder blade, shoulder girdle, half of the neck, interscapular space. Pain syndrome often occurs in the evening and at night, lasts from 15 minutes to 5 hours.

The pain is usually accompanied by nausea, unrelieved vomiting, heartburn, bitterness in the mouth, bitter belching, bloating, and a feeling of fullness in the abdomen. Possible reflex short-term fever up to 38 ° C with chills and sticky cold sweat. The provoking factors are physical activity, stress, infectious diseases, intensive stirring of the child in late pregnancy, nutritional errors (consumption of large amounts of eggs, cream, sweet pastries, fatty fried meat, carbonated drinks).

Complications

In 33% of women with gallstone disease, there is a threat of interruption of gestation. The risk of spontaneous miscarriage or preterm birth increases after gallbladder surgery in the 1st and 3rd trimesters. In 13% of patients, there are pronounced signs of early toxicosis with excruciating nausea, indomitable vomiting, less often – intense salivation, which drags on until the 16-20th and even 28-29th weeks of the gestational age. Preeclampsia develops in 8% of patients. Anomalies of labor activity are diagnosed in every fourth birth.

In rare cases, cholelithiasis in pregnant women is complicated by extragenital surgical pathology. In 0.01-0.1% of cases, a typical clinic of acute cholecystitis is formed due to the wedging of a stone into the bladder neck. In 0.03% of women, acute biliary pancreatitis may occur due to the discharge of the formed calculus along the common duct, and in half of the patients, similar attacks were noted before pregnancy. Even less frequently, when cholelithiasis is combined with gestation, cholangitis, hepatosis, intestinal obstruction and peritonitis are observed.

Diagnostics

The diagnosis of gallstone disease in pregnant women is often difficult due to the asymptomatic course of the disease. With characteristic complaints of a feeling of bitterness in the oral cavity, frequent heartburn, especially associated with the use of fatty and fried foods, the patient is prescribed a comprehensive examination aimed at identifying cholelithiasis. The most informative methods are:

• Ultrasound of the gallbladder. Sonography is considered the gold standard for diagnosing gallstones. Calculi have the appearance of hyperechoic formations of various shapes with a distal acoustic shadow. Vesical walls are often thickened up to 2 mm or more. The sensitivity of the echographic method reaches 95%. With the help of ultrasound, inclusions with a diameter of 2 mm are determined.
• Duodenal sounding. The study is used only in difficult diagnostic cases in the absence of a threat of termination of pregnancy. Probing allows you to evaluate the dynamics of discharge and the composition of portion B (vesical bile). In the duodenal contents, crystals of cholesterol, calcium bilirubinate can be found. Bacteriological analysis is possible.
• Blood test. In cholelithiasis, the level of conjugated bilirubin often increases. With the localization of stones in the common bile duct, the presence of fever and jaundice, the activity of alkaline phosphatase, ALT, AST, GGT may increase, and other liver tests may change. Often increases the content of cholesterol in the blood plasma. In the general blood test, leukocytosis and an increase in ESR are possible.

Differential diagnosis of cholelithiasis is carried out with acute appendicitis, pancreatitis, gastroduodenitis, pyelonephritis, renal colic in urolithiasis and glomerulonephritis, perforation of a stomach or duodenal ulcer, ectopic pregnancy. If necessary, in addition to the obstetrician-gynecologist and gastroenterologist, the patient is examined by a surgeon, urologist, hepatologist.

Treatment of cholelithiasis in pregnant women

The choice of medical tactics for cholelithiasis depends on the clinical form of the disease, the leading symptoms and the presence of complications. With an asymptomatic variant of the disease, pregnant women are prescribed dynamic monitoring and the exclusion of factors that provoke colic (rich food, fried and fatty foods, bumpy driving.). In the postpartum period, cholecystectomy may be indicated for such women, since gallstone disorder often manifests itself during the first year after childbirth.

To reduce bile stasis and prevent the formation of biliary sludge at the initial stage of cholelithiasis, a pregnant woman is recommended frequent fractional meals, drinking highly mineralized mineral waters, taking herbal choleretic agents – decoctions of immortelle, corn stigmas, peppermint, dill seeds or pharmaceutical preparations based on them. Drug therapy of latent subclinical variants of cholelithiasis includes the following groups of drugs:

• Choleretics. Cholagogue drugs that stimulate bile formation in the liver are indicated when hyperkinetic dysfunction of the gallbladder is detected. This disorder is more often observed in the first trimester of pregnancy. The appointment of combined agents containing digestive enzymes in the composition also allows you to normalize the functions of the gastrointestinal tract.
• Cholekinetics. Medicines of this group have a mild antispasmodic effect, facilitate the discharge of gallbladder bile. The safest cholekinetic drugs for the fetus and pregnant women are myotropic antispasmodics, flavone aglycones, hypertonic magnesium solution, sweeteners (xylitol, sorbitol, mannitol).
• Antibiotics. In cholelithiasis, antibacterial agents are used to a limited extent (only with reliable confirmation of the infectious process). In the 1st trimester, it is possible to prescribe drugs from the penicillin group, in the 2nd-3rd trimesters, cephalosporins are more often administered. When choosing a specific antibiotic should take into account the sensitivity of the microflora.

To stop biliary colic, antispasmodics are usually used. Abroad, analgesics are widely used to relieve pain, but domestic experts refrain from prescribing drugs that can lubricate the clinical picture with unclear abdominal pain. In the absence of the effect of drug therapy within 5 hours, a pregnant woman with hepatic colic must be urgently hospitalized in a surgical hospital.

Surgical methods of treatment are indicated in the presence of complications. Conservative expectant tactics with constant aspiration of the contents of the duodenum and stomach, the use of enveloping agents, choleretic drugs, adsorbents, antispasmodics, massive detoxification and antibiotic therapy is only permissible in acute catarrhal cholecystitis. With the ineffectiveness of drug treatment carried out within 4 days, cholecystectomy is performed at any gestational age. In an urgent order, the operation is performed in the diagnosis of destructive forms of inflammation.

The planned removal of the bladder is carried out with a manifest course of cholelithiasis 3-4 weeks after an attack of colic due to the high probability of its recurrence. The intervention is usually performed by laparoscopic or open method in the second trimester, since this period is the safest for such a surgical intervention. Extracorporeal shock wave lithotripsy is not used during pregnancy, which is associated with a high frequency of recurrence of cholelithiasis. Pregnant women with cholelithiasis are recommended for natural childbirth with a shortened period of exile. Caesarean section is performed in the presence of obstetric indications.

Prognosis and prevention

In uncomplicated forms of gallstone disease, the prognosis for the pregnant woman and the child is favorable. Adequate conservative therapy, the use of modern techniques of surgical treatment and anesthesia with removal of the gallbladder in the 2nd trimester (if indicated) made it possible to minimize the likelihood of extragenital, obstetric and perinatal complications. In 60-80% of cases, biliary sludge that occurs in a pregnant woman regresses on its own after childbirth.

Spontaneous resorption of stones formed during gestation is observed only in 20-30% of patients. As a preventive measure, women who are planning a pregnancy and suffer from cholelithiasis are advised to undergo a course of medical or surgical treatment in advance. At the stage of pregnancy, you should strictly follow a diet, refuse long breaks between meals, reduce the consumption of sweets, fatty and fried foods, and follow medical recommendations.

You can share your medical history, what helped you in the treatment of gallstone disease in pregnant women.

Sources

1. Cholelithiasis and its complications: teaching aid / ed. Lobankova V.M. — 2010.
2. Pregnancy and cholelithiasis/ Kolpakov N.A.// Far Eastern Medical Journal. – 2005.
3. Chronic calculous cholecystitis of pregnant women (clinical case) / Trefilova M.A., Gafurova M.M.// Bulletin of science and education. – 2017.
4. EASL clinical guidelines for the prevention, diagnosis and treatment of gallstone disease / Journal of Hepatology. – 2016 – T. 65.
5. This article was prepared based on the materials of the site: https://www.krasotaimedicina.ru/

IMPORTANT
Information from this section cannot be used for self-diagnosis and self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Why is cholecystitis dangerous during pregnancy – Omega-Kyiv 9 guide0001

Cholecystitis is an inflammatory process of the gallbladder wall. The disease is quite common and occurs in more than 3% of pregnant women.

The main cause of the disease lies in the infection or stagnation of bile.

Among the bacteria that cause cholecystitis, the most common microbes are streptococci and Escherichia coli. Also, quite often the cause of cholecystitis can be cholelithiasis.

Among other reasons, a special place is occupied by:

• Bile flow disorders;
• Chronic diseases of the intestines, pancreas and liver;
• Wrong and irregular diet;
• Obesity;
• Diabetes mellitus;
• Pregnancy.
• Occurrence of cholecystitis during pregnancy.

During pregnancy, chronic cholecystitis makes itself felt in almost every clinical case. The exacerbation of the disease occurs due to an increase in the size of the uterus. Changing the usual size, the uterus has a squeezing effect on the organs of the digestive tract. There is stagnation of bile and the formation of stones that block the outflow. The occurrence of acute cholecystitis during gestation occurs due to infection in the body. Also, the occurrence of the inflammatory process of the gallbladder wall can be affected by a significant decrease in immunity, stress and depression during pregnancy.

Most often, the symptoms of cholecystitis occur in pregnant women in the third trimester and are accompanied by late toxicosis and vomiting.

Symptoms of cholecystitis during gestation:

• Pain on the right side of the ribs. The pain can change character and move to the liver, give to the back;
• Excessive sweating, unhealthy complexion, dizziness and fainting;
• In some cases, a slight increase in temperature may be observed.

Why is cholecystitis dangerous during pregnancy?

If characteristic symptoms occur, the expectant mother should contact her doctor and get an appointment for a comprehensive examination. Due to severe pain, against the background of nervous exhaustion, a woman may begin premature birth. In an advanced stage, the expectant mother may need therapeutic assistance during pregnancy and even a cholecystectomy. The procedure involves surgery and removal of the gallbladder.

Also, untimely treatment of cholecystitis can lead to the spread of infection in the abdominal cavity, which is fraught with damage to other organs.

To prevent the occurrence of cholecystitis during pregnancy, it is necessary to adhere to a proper and healthy diet. Or rather, avoid eating fried, spicy and fatty foods. Also, you should limit the intake of factory-made confectionery, snacks and sweet sparkling water. These food restrictions will not only prevent cholecystitis, but also the basis for the healthy development of the fetus.