A review of the management of gallstone disease and its complications in pregnancy.
BACKGROUND
Symptomatic gallstone disease is the second most common abdominal emergency in pregnant women. There have been significant developments in the management of gallstone disease, but risk to the fetus has prevented their routine application in pregnant women. We reviewed the literature to find the current best evidence for the management of gallstones and its complications in pregnancy.


METHODS
MEDLINE and PubMed literature searches were performed to identify original studies.


CONCLUSIONS
Six studies comparing conservative with surgical management of cholecystitis showed no significant difference in incidence of preterm delivery (3.5% vs 6.0%, P = .33) or fetal mortality (2.2% vs 1.2%, P = .57). There was no maternal or fetal mortality in 20 reports of laparoscopic cholecystectomy and 9 reports of endoscopic retrograde cholangiopancreatography, thus indicating their safety when performed with necessary precautions. Laparoscopic cholecystectomy is a safe procedure in all trimesters. In 12 reports of gallstone pancreatitis, fetal mortality was 8.0% versus 2.6% (P = .28) in conservative and surgical groups, respectively, suggesting the need for earlier surgical intervention.
Date
R S
RS
Department of Gastrointestinal Surgery, Lancashire Teaching Hospital NHS Foundation Trust. ravidate@hotmail.com
Kaushal
M
M
Ramesh
A
A
D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000209:etiology / Q000628:therapy; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000628:therapy*; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000628:therapy; D010195:Pancreatitis / Q000209:etiology / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011256:Pregnancy Outcome