How Gallstones Are Treated During Pregnancy

What do you do about gall stones in pregnancy?

Man holding pregnant girlfriendís belly
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Gallstones: A Common Issue During Pregnancy

Gallstones are concentrated lumps of a substance called bile. Bile is made up of water, fat, cholesterol, bilirubin and salts. Ordinarily, bile is released into your small intestine where it helps digest fats. Sometimes, however, bile can become concentrated and form "stones." Gallstones left untreated can lead to infection or even to 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 5-8% of women will experience either sludge or gall stones in pregnancy.

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

What Are the Symptoms of Gallstones?

Sometimes -- but not always -- gallstones can cause significant symptoms including:

  • Potentially fever

It is important to note that not all women will experience symptoms with their gall stones in pregnancy. To figure out if your symptoms mean that you have gall stones in pregnancy, you may have some tests done. Blood work may not be as useful in pregnancy due to normal pregnancy changes.

Though ultrasound can be used to detect many of the cases of gall stones in pregnancy.

How Are Gallstones Treated During Pregnancy?

In looking at your symptoms and test, your practitioner can recommend that you either have surgery or wait the gall bladder attack out. What can you do other than surgery for gallstones in pregnancy? You can try to alter your diet. This can include the recommendation to lower your intake of fried and fatty foods. You may also be given medications for the pain. Some practitioners prefer to go ahead and operate because of the increased risk of a relapse, which can be worse.

First Trimester
Surgery is generally not recommended in the first trimester except for 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 the pregnancy.

Second Trimester
Surgery is safest in the second trimester.

It is also the easiest time to do the procedure with a laparoscopy as opposed to an open incision, which is larger and requires a longer healing time.

Third Trimester
You may be more likely to be encouraged to try to wait it out rather than have surgery. The 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. It may also be recommended that you have your gall bladder removed in the postpartum period.

Sources:
Gallstones. National Digestive Diseases Information Clearing House. NIH Publication No. 07–2897. July 2007.

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

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