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Pregnant women are at risk for developing gallbladder disease.
Gallbladder disease affects approximately 10 to 15 percent of all adults in the United States at some point during their lifetime. The risk of gallbladder disease is higher in pregnant women, due to changes in hormones. In fact, gallstones have been found in 5 to 12 percent of pregnant women, and the risk appears to increase along with the number of pregnancies. Management of gallbladder issues depends on the severity of symptoms, the effect on the fetus and the likelihood of complications.
Bile, the fluid that helps the body digest fats, is produced by the liver and stored in the gallbladder until needed for digestion. Many gallstones are silent, which means that they don't cause symptoms. If a gallstone blocks a tube through which bile normally flows, called a bile duct, the person may have a sudden, severe attack of nausea, vomiting and right upper quadrant abdominal pain, a condition called biliary colic. These episodes can become chronic, with attacks alternating with periods of feeling well.
Many gallbladder problems, however, don't require treatment unless symptoms occur. On the other hand, an acutely ill pregnant woman with biliary colic may need hospitalization to manage her pain and prevent dehydration with intravenous fluid replacement. If the woman has signs of infection, including a low-grade fever, antibiotics may be needed as well. Cholestasis of pregnancy, a condition that causes severe itching due to a slow-down of the flow of bile, is uncomfortable for the mother, but could be life threatening to the unborn baby, so treatment includes administering medication to stop the itching as well as close monitoring of the fetus until delivery.
The treatment of choice for gallstones is surgical removal of the gallbladder, a procedure called cholecystectomy. Removing the gallbladder resolves the woman's symptoms and prevents future episodes of gallbladder attacks. Laparoscopic cholecystectomy, a minimally invasive procedure that uses special instruments to remove the gallbladder through tiny incisions in the abdomen, is safe for pregnant women in any trimester, according to guidelines from the Society of American Gastrointestinal and Endoscopic Surgeons -- SAGES. However, the Society for Surgery of the Alimentary Tract advises that it may be necessary to use the open cholecystectomy approach -- surgery through a wide abdominal incision -- if the procedure is performed in the third trimester to avoid damaging the uterus, as well as to make it easier to remove the gallbladder.
Gallstones that block the common bile duct between the gallbladder and the small intestine, a condition called choledocholithiasis, can be removed successfully in pregnant women using endoscopic retrograde cholangiopancreatography -- ERCP. The procedure involves advancing a thin, flexible tube through the mouth into the opening of the common bile duct. Dye is injected through a catheter in the tube, and a small video camera on the end of the tube allows visualization of the stones. The stones can then be removed through the tube. Since small amounts of radiation could affect the fetus, the woman's abdomen should be shielded during the procedure.