Pregnancy is a time of immense joy and anticipation for expecting mothers, but it can also bring about unexpected health challenges. One such challenge that may arise during pregnancy is the development of gallstones.

Pregnancy and Gall Stones

Gallstones are hardened deposits that form in the gallbladder, often causing pain and discomfort. For pregnant women, managing gallstones becomes a delicate balancing act, as the well-being of both the mother and the growing baby must be carefully considered. Pregnancy is one of the most common conditions associated with the development of gallstones. Almost 4-12% of patients are prone to developing gallstones during pregnancy.

About 70% of the patients managed conservatively. Asymptomatic gall stones must be left untreated till the delivery of the baby.

 

Symptoms of Gallstones during Pregnancy

Symptoms of Gallstones during Pregnancy are more or less the same as when you are not pregnant.

The main symptom of gallstones is a sharp pain in the upper right part of the stomach or ribs. Generally, there are two types of pain: Biliary Colic and Cholecystitis.

Biliary Colic occurs when a stone is blocking a bile duct. It can last for about an hour after eating a fatty meal. This happens as a result of a contraction around the stone.

Cholecystitis occurs due to inflammation of the gall bladder and is usually much more severe. This pain can move to the back and shoulder area and may last six hours or even more.

Gallstones During Pregnancy

 

Managing Gall Stones During Pregnancy

  • Dietary Modifications: A low-fat diet can help reduce the frequency and severity of gallstone symptoms. Avoiding fatty, fried, and spicy foods can ease the burden on the gallbladder and prevents making the symptoms worse.

  • Hydration: Adequate hydration is essential for maintaining bile flow and preventing gallstone formation. Pregnant women should aim to drink plenty of water throughout the day, particularly between meals.

  • Physical Activity: Gentle exercise, such as walking or prenatal yoga, can help improve digestion, prevent constipation, and reduce the risk of gallstone-related complications. Do take plenty of rest to ease your body’s workload

  • Medications: In some cases, healthcare providers may prescribe medications to manage gallstone symptoms during pregnancy. However, the safety of certain medications during pregnancy needs to be carefully evaluated, so always consult with a healthcare provider before taking any medication.

  • Monitoring and Follow-Up: Regular monitoring of gallstone symptoms and fetal well-being is crucial during pregnancy. Pregnant women with gallstones may require more frequent prenatal visits to ensure optimal management and timely intervention if complications arise.

  • Surgical Intervention: In severe cases where gallstones cause persistent pain or complications such as gallbladder inflammation or infection, surgical removal of the gallbladder (cholecystectomy) may be necessary. This procedure is generally safe during pregnancy, especially during the second trimester when the risk to the fetus is minimal.

Prevent Gallbladder Stones During Pregnancy

  • Gain only a healthy amount of weight. This is because obesity is associated with a higher chance in the development of gallstones.
  • Eat a high-fibre diet as it ensures a healthy weight gain and is even good for the health of you and the baby.
  • Saturated fats are associated with a higher chance of developing gallstones. It is therefore essential to choose the correct type of fats. Monosaturated fats and omega fatty acids decrease the formation of gallstones.
  • Avoid sugar and refined flour as products made from refined or white flour such as bread, pasta, and chips are more likely to create gall stones.
  • Proper management of diabetes is necessary as diabetes is associated with increased chances of gallstone complications.

    common precautions in gallstone

 

Dealing with Symptomatic Gallstones during pregnancy

You must consult a best gallbladder specialist, especially if you are experiencing ongoing pain in the right side of the upper abdomen, nausea and vomiting, fever or chills, jaundice, or any abdominal pain lasting for five hours.

There are a few things to consider when deciding if gallstone surgery during pregnancy is the right option for you. First, it’s essential to know that any surgery comes with risks. But for pregnant women, those risks can be even more significant. Surgery may increase the risk of premature delivery, miscarriage, or bleeding during labor.

However, surgeons can safely perform surgery during the second or third trimester in patients who have recurrent attacks of gallstone disease or who fail to respond to conservative management.

Laparoscopic removal of gall stones, preferably during the second or third trimester, can be carried out in a specialized setup. Some patients may develop complications and might require ERCP to remove stones present in the common bile duct. However, doctors must take extreme care to prevent exposing the fetus to radiation.

Best time to Operate on Gallstones during Pregnancy

  • Second Trimester: During the second trimester (weeks 14 to 26), surgeons often consider it the safest time for surgical intervention. This is because the risk of miscarriage is lower compared to the first trimester, and the risk of preterm labor is lower compared to the third trimester. Additionally, by the second trimester, the fetus is more developed, reducing the risk of developmental malformations from anesthesia or medications.

  • Gallstone-Related Complications: If gallstones lead to complications such as acute cholecystitis (inflammation of the gallbladder) or choledocholithiasis (stones in the bile duct), surgery may be necessary regardless of gestational age to prevent serious maternal and fetal complications.

  • Elective vs. Emergency Surgery: Whenever possible, healthcare providers typically postpone elective surgery for uncomplicated gallstones until after delivery to minimize the risks associated with anesthesia and surgery during pregnancy. However, in cases of severe symptoms or complications, emergency surgery may be necessary to address acute issues and prevent harm to the mother and fetus.

  • Maternal Health and Stability: The mother’s overall health and stability play a crucial role in determining the timing of surgery. If gallstone-related complications or other medical conditions compromise the mother’s health, doctors may need to perform surgery earlier in pregnancy.

  • Fetal Viability and Development: The decision to perform surgery during pregnancy must also consider the viability and development of the fetus. In cases where the fetus is not yet viable (before 24 weeks gestation), surgery may be delayed if the maternal condition allows, to reduce the risk of harm to the developing fetus.

  • Multidisciplinary Consultation: Healthcare providers should consult a multidisciplinary team, including obstetricians, surgeons, anesthesiologists, and maternal-fetal medicine specialists, to make the decision regarding the timing of gallstone surgery during pregnancy. The team will carefully assess the risks and benefits of surgery based on the individual circumstances of the patient.

By Dr .Kapil Agrawal

Dr. Kapil Agrawal holds 22+ years of rich experience in General Laparoscopic Surgeries (including Gallbladder Stone, appendix removal, hernia surgery, piles, lipoma, circumcision and fissure surgeries) and Bariatric Surgeries. He is a Senior Consultant with the Apollo Group of Hospitals in Delhi. Dr. Kapil has completed over 7000 Laparoscopic surgeries for all National and International Patients. He was associated with North Middlesex University Hospital, Edmonton, UK, and the Aintree University Hospital, Liverpool. He was honored with an MRCS (Member of the Royal College of Surgeons, London, UK) in 2007 in England. He has established a super specialty consultation center, 'Habilite Clinics,' in Delhi, intending to minimize the hospital's stressful experience and provide a warm and compassionate environment to his patients. The clinics offer a holistic program for the management of obesity and various advanced laparoscopic and laser surgeries to manage multiple ailments.

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