Gallstones in pregnancy are relatively common. About 5-8% of women will experience either sludge or gallstones in pregnancy. While it is more common to medically manage gallstones in pregnancy, it is the second most common cause of surgery in pregnancy that isn’t pregnancy related.
I experienced many female patients with postpartum fall stones that develop during pregnancy. Mostly these were symptomatic. Usually these stones are small and multiple. Sometimes the ladies refused surgery and continue conservative medical management including therapy with ursodeoxy cholic acid. With follow up over 3-6 months, I noticed relief of symptoms and disappearance of the stones by ultrasonography. Do you share me this observation? what is the best management in such cases when they are encountered after labor with biliary colic? What is the probability of complications if left untreated?
Dear Mostafa
I think some points need to be remembered concern gall stone and pregnancy
First some symptoms that related to pregnancy might be confused with the symptoms of gall stone e.g heart burn, vomiting etc
Secondly during pregnancy there is a high progestrone levels which has smooth muscles relaxing effects, there fore we expect this effect will lead to some improvement of the gall stone related symptoms.
Thirdly the pregnant uterus and the inside fetus are very sensitive to any procedure and might be influenced by any intervention of the gall stone
Thus I think to keep our razor away during pregnancy
Warm Regards
If the gallstones is large enough,>2cm and multiple,the chances of success with dissolution therapy is very low indeed.
If the symptoms of colic or inflammation is persistent,then laparoscopic cholecystectomy is required
My experience regarding gall stones dissolution (whether spontaneously or related to ursodeoxycholic acid) is mostly noticed symptomatic in women after delivery. I am not sure whether stones disappeared due to their passage through the CBD to the duodenum or their dissolution. I suggest the later, as stones were not seen on ultrasound examination after complete cure from the biliary colic (usually 3-6 months). Meanwhile in patients with chronic liver disease and gall stones, I usually recommend ursodeoxycholic acid. After a variable period of follow up I noticed a decrease in the size of the stones and in few cases their disappearance. However, most of these patients were not suffering from the stones. I found a nice reference that discusses my query.
http://www.tripanswers.org/Answer.aspx?qid=2789
http://www.hubmed.org/display.cgi?uids=12831489
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