Skip to main content

Pregnancy and Cholelithiasis

  • 102 Accesses


Pregnancy predisposes women to cholelithiasis due to the hormonal effects of estrogen and progesterone on cholesterol, soluble bile acid secretion, and gallbladder emptying. Gallstones cause biliary colic, acute cholecystitis, gallstone pancreatitis, choledocholithiasis, gallstone ileus, and cholangitis. Signs and symptoms include intermittent right upper quadrant pain, nausea, vomiting, epigastric pain, anorexia, intolerance of fatty foods, fever, elevated white blood cell count, elevated amylase and lipase, elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT), jaundice, and positive Murphy’s sign. Findings of cholecystitis on ultrasound are thickened gallbladder wall (>3–5 mm) or edema, presence of gallstones, pericholecystic fluid, and a sonographic Murphy’s sign. Cholecystectomy is clearly indicated for obstructive jaundice, acute cholecystitis failing medical therapy, gallstone pancreatitis, or suspected peritonitis. Conservative management has a 38% chance of suboptimal outcome, with a 34% risk of relapse, and increased severity of disease at relapse. The consideration for definitive surgical management of gallstone disease during pregnancy, especially in the first and second trimesters, is supported.


  • Gallstones
  • Pregnancy
  • Cholelithiasis
  • Cholecystitis
  • Gallstone pancreatitis
  • Choledocholithiasis
  • Gallstone ileus
  • Cholangitis
  • Murphy’s sign
  • Cholecystectomy
  • ERCP
  • MRCP

This is a preview of subscription content, access via your institution.

Buying options

USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-319-98497-1_204
  • Chapter length: 4 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
USD   189.00
Price excludes VAT (USA)
  • ISBN: 978-3-319-98497-1
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Hardcover Book
USD   249.99
Price excludes VAT (USA)


  1. Gilo NB, Amini D, Landy HJ. Appendicitis and cholecystitis in pregnancy. Clin Obstet Gynecol. 2009;52(4):586–96.

    CrossRef  Google Scholar 

  2. Williamson C, Mackillop L, Heneghan MA. Diseases of the liver, biliary system, and pancreas. In: Creasy and Resnik’s maternal fetal medicine: principles and practice. 7th ed. Philadelphia: Elsiever; 2014.

    Google Scholar 

  3. Date RS, Kaushal M, Ramesh A. A review of the management of gallstone disease and its complications in pregnancy. Am J Surg. 2008;196(4):599–608.

    CAS  CrossRef  Google Scholar 

  4. Sharp HT. The acute abdomen during pregnancy. Clin Obstet Gynecol. 2002;45(2):405–13.

    CrossRef  Google Scholar 

  5. Diegelmann L. Nonobstetric abdominal pain and surgical emergencies in pregnancy. Emerg Med Clin N Am. 2012;30:885–901.

    CrossRef  Google Scholar 

  6. Lu EK, Curet MJ, El-Sayed YY, Kirkwood KS. Medical versus surgical management of biliary tract disease in pregnancy. Am J Surg. 2004;188:755–9.

    CrossRef  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Jaimey M. Pauli .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and Permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Verify currency and authenticity via CrossMark

Cite this chapter

Pauli, J.M. (2019). Pregnancy and Cholelithiasis. In: Docimo Jr., S., Pauli, E. (eds) Clinical Algorithms in General Surgery . Springer, Cham.

Download citation

  • DOI:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-98496-4

  • Online ISBN: 978-3-319-98497-1

  • eBook Packages: MedicineMedicine (R0)