Pregnancy without a gallbladder

Diet for Gallstones during Pregnancy

One of the main signs of having gallstones is intense abdominal pain, particularly after having foods that are high in fat. The problem in treatment during pregnancy is that all the patient is left with is lifestyle modification and symptom management as surgical procedure for removal of gallstones cannot be carried out. If you are a pregnant woman, your diet for gallstones during pregnancy should be low in fat to bring down the frequency of gall bladder attacks and their intensity.

Some of the guidelines you should follow to plan your diet for gallstones and pregnancy are:

Reduce fat intake

If you have a large gallstone, eating any kind of fat would trigger a painful reaction. Reducing the dietary fat is an effective way to improve this symptom. It involves certain dietary modifications such as substituting red meat with skinless ones, having low fat yoghurt rather than butter and in place of cooking oils. It would be advisable to plan a diet with more of vegetables than meat. If you are able to reduce your dietary fat, it would not only reduce the intensity of gall bladder symptoms but also help you maintain healthy weight all through your pregnancy.

Include more of fibre in your diet

You need to have more of fibrous foods for managing gallstones in pregnancy. Fruits, vegetables and whole grains are rich in fibre and pregnant women are recommended to consume 4-5 cups of fruits daily. You should plan a meal keeping this in mind.

One of the ways of increasing fibre content in your food is by mixing dried apricots with oatmeal or vegetables rich in vitamins, such as tomato and baby spinach, in your sandwich. Avoid mayonnaise and cheese as they have a high fat content. Berries, kale, broccoli and other dark coloured fruits and vegetables are preferable. They are good for the development of your baby too. Certain important nutrients such as folate and iron are found in these vegetables which aid in the brain and organ development of your baby.

Drink the right amount of water

With adequate hydration of your body, the additional fibre consumed can be broken down and nutrients can easily travel to the uterus. Pregnant women are recommended to have an intake of at least ten glasses of fluids daily. This does not mean they can consume sodas and other sweetened beverages. The pregnant women should be aware of the healthy fluids that they can consume, which the sodas are certainly not with their hundreds of empty calories. Citrus fruits mixed in water are a much better alternative to sweetened or caffeinated beverages.

Read more articles on Pregnancy Diet

Gallbladder Diet Plan for Pregnant Women

The gallbladder is a small sac beneath your liver that stores and releases bile, a fat-dissolving substance, into your intestinal tract. Gallstones develop when residual bile hardens into solid clumps. These large stones can block the exit duct, causing a gallbladder attack, which results in acute abdominal pain, nausea or vomiting. An increase in estrogen levels during pregnancy make pregnant women more likely to develop gallstones. Modifying your diet during pregnancy can decrease the severity of your gallbladder attacks, even if gallstones are already present.

Reduce Your Fat Intake

Eating any type of fat triggers a reaction from your gallbladder, which becomes painful if you suffer from large gallstones. According to Dr. Frank Jackson at Jackson Siegelbaum Gastroenterology, reducing your dietary fat can improve your gallstone symptoms. For example, replace red meat with skinless, light-meat poultry, and use low-fat yogurt instead of butter or cooking oils. These changes reduce gallbladder activity, which reduces the risk of an attack. Additionally, decreasing your dietary fat helps you maintain a healthy weight throughout your pregnancy.

Eat More Fiber

Increasing your dietary fiber by eating more fruits, vegetables and whole grains improves digestion and relieves your gallbladder. According to MayoClinic.com, pregnant women should eat between 4 and 5 cups of fruit or vegetables each day. Mix a handful of dried apricots into your oatmeal or add vitamin-rich vegetables, such as baby spinach and tomato, to your sandwich instead of cheese and mayonnaise. Darkly colored fruits and vegetables, such as berries, kale and broccoli also provide important nutrients for your baby’s brain and organ development, such as folate and iron.

Hydrate

Proper hydration allows your body to break down the extra fiber and helps transport the nutrients you eat to your uterus. According to MayoClinic.com, pregnant women need approximately 10 glasses of fluid each day. Sodas and other sweetened beverages technically qualify as fluid, but they also pack hundreds of empty calories. Plain water with a twist of citrus fruit is a much healthier alternative that will help you avoid the extra sugar calories and caffeine.

Eat Whole Foods

Choose fresh, whole foods over refined or processed items. For example, eat fresh spinach instead of canned creamed spinach and whole-wheat bread instead of white. Reducing, or eliminating, highly processed foods that contain preservatives, trans fats and other additives can ease symptoms of gallstones, reports the University of Maryland Medical Center 1. Packaged snack foods such as snack cakes, crackers and chips are chief offenders in this category. Instead, prepare your own snacks before leaving the house, such as apple slices and pita strips with hummus.

How to Manage Gallstones in Pregnancy

Gallstones…. very common in pregnancy. Did you experience them?

One of our mum asks: ” I am 32 weeks pregnant and have just found out I have gallstones. I was wondering if you could ask your followers for some advice as I’m getting attacks at least twice a day I don’t eat much fatty foods and am trying to cut out as much as I can and was wondering if anyone else has been thru this and may have done advice.”

Here is what other mums on our Facebook page have shared in reply:

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Ouch I feel your pain! I had them my last pregnancy and the pain to me was worse than childbirth! I had to work out what the triggers were as I didn’t have a bad diet either, for me it was dairy and eggs, I can eat them now a couple yours later and haven’t had an attack in yours, your best bet is to find the triggers for you and avoid them at all costs, good luck!

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Yip been there. Agree you have to figure out your triggers. Diary products were mine even small amounts.

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Surgeon suggested to me to stop eating lettuce as he has found that is a common thing to cause attacks… Unfortunately I have found even a glass of water can set me off… good luck!

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I too feel your pain – I got them about 6 weeks after giving birth and had no luck finding the triggers – even not eating didn’t stop them. I ended up in hospital for 2 weeks with a stone blocking my bile duct and jaundiced. the procedure to unblock it then gave me acute pancreatitis!! Had to wait about 5 months for surgery with attacks every few days and in and out of hospital. Also was trying to work as the main income earner for my family – very stressful!! After my surgery a stone that was left behind got stuck in my bile duct again!! Since then no more attacks but still have to be very careful of what I eat or end up feeling quite unwell

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Omg I got that at 7 months pregnant and my life was over – that’s what it felt like all I could eat and drink I’m not joking was plain rice and water no juice no flavourings nothing plain rice and water was all that worked and I ate that till my daughter was 7 months when I finally got my operation nothing but bare with it hot water bottle panadol is all I can say egg whites are fine but yolks would set a good attack off was awful pain is definitely worse than childbirth

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Yes! I had them last pregnant and all I can do is sympathise as it was hell on earth! I had the gall bladder out at 6 weeks post partum and it was a very good idea, as I’m now 34 weeks with number two and had a much easier pregnancy.

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I got severe attacks after the birth of my first child and they said there were so many stones and it was in a bad way so had emergency surgery to remove them. I found nothing helped with the pain at the time and no matter what I did or ate I would get attacks. Just make sure if it gets bad you pack massive dramas to your doctor so that they do something about it.

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are you sure it’s gall stones? I had quite bad pain (toward end of pregnancy) and they thought it was gall stones but after an ultrasound they found that it was just baby didn’t have much room and kicking my diaphragm which was helped by a chiropractor releasing it.

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Yep I got them 6wks after having my son and my only option was having my gallbladder out! Cold water and dairy used to set off the attacks for me. I hope it calms down for you asap and ask your doctor bout possible removal post partum so you can go on the waiting list now

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I had them in my last pregnancy too that resulted in surgery. Try taking digestive enzymes to help digest your food. Also milk thistle to support your liver and help process the hormones. Apple cider vinegar (tablespoon in a shot of water) also helps and takes the pressure off your gall bladder. Add turmeric to your food (anti-inflammatory and liver support). Hope that helps

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Yip ouchy! I was operated on at 25 weeks pregnant to have it removed after only one attack so unfortunately have no advise but I really hop you are feeling better soon and they can operate once baby is born and the wait is not too long.

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I had really bad gall bladder pain for a night and I drank water with apple cider vinegar in it constantly (probably a litre in two hours, and the a glass an hour for the rest of the day), the pain subsided and never came back. I think mine was linked to dehydration though. I have a history of gall bladder pain, but never confirmed I have stones. Hope that you get some help

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I had mine out after many hospital trips at 22 weeks in the end what I ate made no difference – hormones of pregnancy are the main trigger. Good luck hope it settles. Only advice I have is don’t just write off all pain as the stones, I was in labour and was blaming the operation scars, my midwife said she had a few woman not link labour pains to what they were feeling because they had been putting up with gallbladders that were rumbling or attacking.

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I had undiagnosed gallstones for years but it was really horrible through my third pregnancy i kept thinking something was really wrong as i was in constant pain. i had been to doctors and was told it was constipation, which is wasn’t!! I ended up in hospital when my daughter was 5 months old with a hepatic liver and the worst pain I would rather go through childbirth. i had my gallbladder removed and feel the best i have in years but looking back i realise that the food that triggered my attacks where onions, leeks, cabbage and anything dairy.

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Ouch, worst pain ever…definitely worse than childbirth. I started getting attacks when I was pregnant with number 3. Rushed to hospital twice before they worked out what it was. Luckily I had health insurance and they removed my gallbladder 6 weeks after baby was born. My triggers were ham, sausage rolls and exercising.

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Oh yes I started having attacks at about 18weeks and there wasn’t anything that I knew I could do about it. I had it removed when baby was 1 1/2 years old as I didn’t have the attacks that often but not fun while feeding bubs and being sick.

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Sometimes it’s not food that triggers it either. My husband and I were having a bit of a tickle play with kids. And I had a gallstone block the hole while having a laugh. I had gallbladder removed in the end. After in and out of a and e and also intensive care with bad pancreatitis. Each to your own. Very painful thou definitely worse than child birth.

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Yes. For me it was anything high in fibre. No nuts, or grain bread. Even wheat meal was a problem. No peanut butter either (was actually convinced I had a nut allergy). Even chocolate. Recently had it removed and am feeling so much better for it.

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I feel for you! I had to eat very small, low fat foods. And I drank lemon in my water which really helped. Heated wheat packs for the pain. But still ended up in hospital a week before I had my baby, who was induced. Gallbladder was removed 6 weeks after birth.

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Me to. Those first 6 weeks after bub was born were the worst. Apparently hormones make your gallbladder sluggish. Latest research suggests taking melatonin tablets at the beginning of an attack can help. This has def worked for me. It’s not always fatty foods at all. I found it was when I aye a big meal. Even if it wasn’t fatty at all. A common trigger is also citrus so try avoiding that.

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Yep, just had surgery a week ago to have my gallbladder removed. I could never really figure out what my triggers were. It all started a couple of months after I had my daughter. Was on the public waiting list for surgery since February because removal of the gallbladder is the only way the attacks will never come back.

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I got gall stones a couple of weeks after having my baby I found my self unable to breathe and found myself curled up on the floor in pain and ended up at the hospital every time I had the attacks I couldn’t feed my daughter I ended up going to hospital for a week to get my gall bladder out and the gall stones

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I had gall stones when I wasn’t pregnant and the only thing that helped pre-op was a no-fat diet. Not very healthy and I lost a lot of weight and got every virus going around. But no attacks unless I slipped up and ate fat. No fun either way.

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Feel your pain! I had my first attack 6 weeks after having my first. 2 years on a waiting list to have gall bladder out with almost weekly trips to hospital in that time with attacks. Then another two years of trouble after, in and out if hospital. Finally I went yellow and they opened me up to find a stone blocking my bile duct. For me the only trigger that was clear was lamb fat but still had attacks chronically after cutting that out.

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I had them, went to my osteo after the doctor telling me to get my gall bladder out. Did a detox over the weekend passed them no pain just couldn’t go to far from the toilet and have not had any problems since! My sister and cousin also have done detox and been successful! Better than having surgery

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I suffered with severe gall stone attacks after I had my son. I did a lot of research and found that drinking half a cup of apple cider vinegar and drinking lots of apple juice helped. During an attack take a cup of apple juice and have a shot glass full of apple cider vinegar all at the sane time. There is something in apples that dilates the entrance to the gallbladder therefore reducing the pain. It didn’t fix it completely but it helped. Also avoid dairy/fatty foods. I had my gallbladder out when my son was a few weeks old.

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Oh the mighty gallstones. I had an attack post birth in the middle of the mall. Absolutely painful (more so than giving birth) Ended up in hospital and 10 days later surgery to have gall bladder removed. Apparently its very common for women to get as a result of pregnancy. All to do with the hormones. Not sure about finding the triggers but have to watch your fatty foods intake.

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I take a sip of Apple Cider Vinegar When I think an attack is starting and it seems to help.

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I just had mine out one month ago when my daughter was 5 months old after 2 months of attacks which were excruciating. Mine were mostly triggered by takeout but I had milder attacks after dinner almost every night. Nothing helped except surgery.

Why Pregnancy Can Lead to Gallstones and How to Help Prevent Them

On top of morning sickness, stretch marks, and swollen feet, pregnant women have yet another thing to worry about: gallstones. But despite the increased risk, there are things you can do to help prevent this unwanted side effect of pregnancy.

Gallstones can lead to pain and other symptoms, and if left untreated, they can cause your gallbladder to become infected or even rupture. Women have a 2 to 3 times higher rate of gallstones than men, and hormonal changes that occur during pregnancy put them at even greater risk. Still, gallstones are not an inevitable part of pregnancy if you’re willing to take steps to help avoid them.

What’s the Link Between Pregnancy and Gallstones?

Bile is a liquid produced by your liver that is primarily made of cholesterol, bilirubin, and bile salts. Your gallbladder stores bile until your body needs it, and then releases it into your small intestine, where it helps with the digestion of dietary fat and fat-soluble vitamins. If the substances that make up your bile become imbalanced — too much cholesterol or bilirubin and not enough bile salts, for example — hardened gallstones may form in your gallbladder.

“Pregnant women are at increased risk for gallstones because of increased estrogen levels,” says Jose Nieto, DO, a gastroenterologist at the Borland-Groover Clinic in Jacksonville, Florida, adding that weight gain and rapid weight loss after pregnancy also increase the risk. Increased estrogen is problematic because it can cause cholesterol levels in bile to spike, which can lead to the development of gallstones.

Women who take birth control pills or are on hormone replacement therapy are also at increased risk of developing gallstones since these contain estrogen.

Symptoms of Gallstones During Pregnancy

Sometimes gallstones don’t cause problems or symptoms, and they may go away on their own after you deliver your baby. But it’s important to tell your doctor if you’re having any of the following potential symptoms of gallbladder problems:

  • Steady, severe pain in the upper right portion of your abdomen, especially after eating a fatty meal
  • Pain in the upper abdomen that radiates into your right shoulder and back
  • Abdominal pain that lasts more than five hours
  • Nausea and vomiting
  • Fever or chills
  • Yellowing skin or whites of the eyes (jaundice)
  • Stools that are clay colored

Diagnosis and Treatment of Gallstones During Pregnancy

To confirm a diagnosis of gallstones, your doctor may perform an abdominal ultrasound, much like those you’ve probably already had to see your developing baby.

Make sure your doctor knows that you’re pregnant, since many diagnostic tests for gallstones, such as an oral cholecystogram (X-ray of the gallbladder), computerized tomography (CT) scan, or nuclear scan may not be safe during pregnancy.

Gallstones are most commonly treated by cholecystectomy, which is the surgical removal of your gallbladder. Depending on your symptoms and risk factors, your doctor may choose to carefully monitor you during pregnancy or go ahead and remove your gallbladder while you are pregnant.

How To Prevent Gallstones During Pregnancy

Here’s what you can do to help lower your risk of gallstones during pregnancy:

  • Gain a healthy amount of weight. Obesity is a major risk factor for the development of gallstones in women. Pregnancy is not a time for weight-loss diets, but working with your doctor to avoid excess weight gain can help.
  • Eat a high-fiber diet. Too little fiber can increase your risk of developing gallstones. Eating more fiber-rich foods can help keep your gallbladder — and your baby — healthy.
  • Choose the right fats. Monounsaturated fats and omega-3 fats help prevent gallstones, while foods high in saturated fat tend to promote their formation.
  • Cut back on sugar and other refined carbohydrates. Sugar and products made from white or refined flour — such as many types of bread, pasta, crackers, and chips — increase the risk of gallstones. They also provide mostly empty calories, which is not something you or your baby really need.
  • Manage diabetes. People with diabetes often have high triglyceride levels, and both conditions have been linked to an increased risk of gallstones. So work with your doctor to keep your diabetes under control while you are pregnant.

Avoiding gallstones during pregnancy may just take some small tweaks to your routine. But talk to your doctor if you are at higher risk for gallstones, or are developing any worrisome symptoms during your pregnancy.

Additional reporting by Erica Ilton, RDN.

The first attack came in the middle of dinner prep.

Pain nearly bowled me over while I was setting the table. I had a burning sensation in my chest, and my shoulders, neck, and rib cage felt like they were being tightened by an invisible corset. I couldn’t bend at the waist. I couldn’t breathe.

My husband, convinced I was having a heart attack, shoved aspirin at me and begged me to go to the emergency room. But 30 minutes later, the awful pain (easily the worst I’d felt since labor) was gone.

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I was two months postpartum. My infant son, Bryson, and I had spent most of the summer recovering from premature birth complications. I had a recently adopted daughter, a wildland firefighter spouse who could be called out at any moment, and two foster children. When I wasn’t parenting, I was managing the family business. I didn’t have time to be sick.

Though my pain had gone away, I slowly began to notice other symptoms. The eggs my daughter collected from our backyard chickens made me violently ill (this had never happened before). Coffee, one of the great loves of my life, didn’t sit so well, either. And the small, tight knot that had occupied the right side of my ribs ever since giving birth had begun throbbing dully.

Weeks later, at the end of a family day trip, the pain struck again. One minute I was fine and the next I was sitting bolt upright in the passenger’s seat, white-knuckling the lap belt, silently praying not to vomit as we raced home. Finally, I called my OB’s office.

Pregnancy creates “the perfect storm of situations” for gallbladder trouble.

“I think I need my gallbladder checked,” I said. After speaking to a few other moms, I’d grown suspicious that I had gallstones. This complication is frequently whispered about among moms but somehow is rarely acknowledged in pregnancy guidebooks. No sooner had I confided my pain to a few female relatives than the stories began flooding in that matched my symptoms.

The gallbladder is a small-ish, somewhat optional organ that stores bile produced by the liver. Bile, along with bile salts, is used to break down fats during the digestive process. When something upsets this basic balance, gallstones — including the type most commonly seen in pregnancy, known as lipid or cholesterol-laden stones — can form.

Unfortunately, pregnancy creates “the perfect storm of situations” for gallbladder trouble, says Christopher Robinson, M.D., of the Society for Maternal-Fetal Medicine. Hormonal and weight changes associated with pregnancy are more likely to cause gallstone problems.

In general, gallstones are pretty common, and most of the time, they go unnoticed. “Think of it like a working condition that is out there in your life, every day,” Dr. Robinsons says. “It’s not that pregnancy causes it, but it probably uncovers it.”

Pregnancy slows down the entire digestive system, contributing to sludge buildup in the gallbladder, Robinson notes. Estrogen and progesterone, both key pregnancy hormones, impact biliary secretions. And pregnancy also changes the way your body deals with fats. “In supporting the baby, the fat content in your blood actually increases very dramatically,” Robinson said. Even if you consume less fat, your body will continue working to send fat to the fetus.

Author Kate Wehr and family. Bryson Wehr, pictured at 9 months, arrived nearly four weeks ahead of schedule in June 2018 Bill Schwab

Expecting mothers in their twenties and thirties have about a 6.5% chance of developing stones, an incidence that increases to nearly 12% by the time they hit their forties. Genetics, obesity, and previous pregnancies all up a mother’s risk of gallstones. Surprisingly, so do postpartum weight loss and breastfeeding, both otherwise healthy behaviors, because these conditions both involve more fat moving through the body.

After revealing my gallstone issues to others, I quickly realized I wasn’t alone. Dorie Turner Nolt, 39, a consultant in Washington, D.C., had a “textbook” pregnancy until it was time to deliver and she wound up with multiple complications (an emergency caesarian section, a severe infection, and two more surgeries). A week after returning home from her last surgery, she woke up to a gallbladder attack.

Because she was still healing, another operation to remove her gallbladder would be dangerous so her doctor suggested she restrict her diet to help ease her symptoms. “For 10 months, I ate as little fat, sugar, and carbs as possible,” she says. “I took supplements. I did gallstone cleanses to try and break up the stones. I drank apple cider vinegar daily, which was supposed to help with inflammation. Despite all of that, I still had attacks every few weeks that were absolutely miserable. Severe pain, vomiting, and exhaustion.” She finally had her gallbladder removed last spring, via an existing surgical scar.

Like Nolt, I was advised to try altering my diet first. Ultrasound analysis had confirmed my suspicions — I had gallstones, lots of them — yet because my symptoms were atypical, I was told that operating might not fix the problem. I acquiesced until last November, when my children witnessed the onset of a severe attack while I was driving. More than five hours of horrendous pain, nausea, and vomiting later, I was done. For me, gallstones had become a family safety issue, and I opted for a laparoscopic cholecystectomy — full gallbladder removal — shortly after Thanksgiving.

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As troubling as postpartum complications like mine are, the risks associated with premature delivery mean expecting mothers dealing with severe gallstone pain face a doubly hard situation. Gallbladder disease in pregnancy contributes to premature birth, a February paper from the American College of Surgeons found. The study concluded that, in order to preserve mothers’ health and allow babies more time to develop, surgical intervention in pregnant women should be avoided as much as possible.

That’s what Ashley Cotterell, 27, had to think about when she headed for the emergency room at 33 weeks. Then pregnant with her fourth child, Cotterell, an event planner in Bozeman, Mont., said kidney stones had complicated all of her pregnancies, but this time, the pain was worse, and in a different location.

It turned out that Cotterell had developed both kidney and gallstones, and her pain level meant her gallbladder needed to come out. She prepared for an emergency induction by taking steroids to strengthen her unborn child’s lungs before delivering her son Mason at 34 weeks. While her baby was in another room being treated for low body temperature and jaundice, Cotterell underwent a cholecystectomy.

Despite the severity of our respective experiences, gallbladder complications never came up at any of our prenatal visits.

That may be because physicians don’t want patients to dismiss what could be life-threatening complications — such as preeclampsia or pancreatitis — as simply gallstone pain, which you can do very little about. “We want to know about these symptoms,” Dr. Robinson says. “We don’t want a person writing it off as, ‘Well, it’s probably just my gallbladder.’”

As more women delay getting pregnant, however, their odds of gallstone problems increase. “Gallstones in our practice, in maternal-fetal medicine, are probably like every week,” he says. “They’re not that infrequent anymore.”

Nine months into new motherhood, the issue, for us, seems to be officially resolved. My postpartum figure now sports four small purple scars, quiet testament to what carrying my son put me through.

He’s been worth every single one of them.

Kate Wehr Kate Wehr is a freelance writer and a former reporter; she lives in western Montana with her husband, four children, a flock of opinionated poultry, a retired therapy pony, and one very noisy Australian shepherd.

Abdominal Pain in Pregnancy, Gallstones

You have pain in your upper belly (abdomen) that may be caused by gallstones. The gallbladder is an organ that stores fluid called bile. The gallbladder sends bile into the intestines to help you digest your food. A small amount of bile sometimes stays in the gallbladder. In time, this bile can harden, forming gallstones. If stones move into the tube (duct) that carries bile out of the gallbladder, they can cause pain or infection.

Gallstones are more likely to occur during pregnancy. This is because you have higher amounts of hormones at this time. Other things that make it more likely to have gallstones are family history and a diet that’s high in fatty foods.

One common symptom is pain and cramping in your belly, usually after you eat. The pain is in the upper right part of your belly. These are other common symptoms of gallstones:

  • Nausea and vomiting
  • Loss of appetite
  • Itching without a rash
  • Jaundice
  • Pale-color stool
  • Dark urine
  • Fever

You and your healthcare provider will decide on the best treatment for you. Here’s what you can do to ease your discomfort in the meantime.

Home care

Medicines

Your healthcare provider may prescribe medicine to help relieve pain. Follow your healthcare provider’s instructions for taking these medicines.

General care

Although you can’t control your family history or your hormones, you can make changes to your diet. Changing your diet won’t fix your gallbladder, but it may help with the symptoms. Here are some general care guidelines:

  • Eat a diet that’s high in fiber and low in fat. Avoid greasy or fried foods.
  • Read food labels to be sure the foods you are choosing are low in fat.
  • Limit high-fat meats, dairy products, animal fats, and vegetable oils.
  • Keep all appointments with your healthcare provider. Your provider needs to watch your condition.

Surgery for gallstones is generally not done during pregnancy unless the gallstones are causing severe pain or you have an infection. Discuss your treatment choices with your provider. You might need:

  • Medicine to dissolve the stones
  • A procedure called an ERCP to find the stones and remove them. The ERCP uses a thin tube with video and X-rays.
  • Surgery to remove the gallstones

Even after treatment, gallstones can return.

Follow-up care

Follow up with your healthcare provider, or as advised.

Call 911

Call 911 if any of these occur:

  • Severe lightheadedness, passing out, or fainting
  • Rapid heart rate
  • Trouble breathing
  • Confusion or difficulty waking up

When to seek medical advice

Call your healthcare provider right away if any of these occur:

  • Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider
  • Severe pain in the upper belly, shoulder, or back
  • Nausea or vomiting
  • Yellowing of the skin or eyes (jaundice)
  • Vaginal bleeding, leakage of fluid from the vagina, or lack of fetal movement

Date Last Reviewed: 6/1/2016

PMC

DISCUSSION

Approximately 1 in 500 pregnancies is complicated by a non-obstetric surgical condition. Appendicitis, cholecystitis and ileus constitute the major surgical conditions.

Clinical symptoms are nonspecific and physical examination may be difficult to perform due to the enlarged uterus, making a precise diagnosis problematic.

Biliary tract disease is reported to represent the second most non obstetric surgical emergency during pregnancy. It has been postulated that pregnancy is associated with an increased percentage of colic acid, increased cholesterol secretion, increased bile acid pool size, decreased enterohepatic circulation, decreased percentage of chenodeoxycholic acid and increased bile stasis. Pregnancy was once an absolute contraindication for laparoscopy. Nowadays, in the absence of a prospective, randomized, controlled trial comparing laparoscopic cholecystectomy, open cholecystectomy and conservative medical management for pregnant patients with symptomatic cholelithiasis, retrospective case reports and series provide some insight into the relative benefits of each treatment modality. Many studies have demonstrated suboptimal clinical outcomes following conservative medical treatment in these patients. These studies believe maternal illness pose a greater threat to the fetus compared to surgery. They have shown readmission to be greater than 50% in these patients; moreover, spontaneous abortion or preterm labor was reported in 16% of them. Laparoscopic surgery is also associated with a lower incidence of premature delivery because of decreased uterine manipulation.

As a result, many studies support that laparoscopic cholecystectomy can be safely performed during pregnancy. In a recent review of literature, no complications of surgery were reported. Moreover, laparoscopy is also an excellent tool when the diagnosis in a pregnant patient is uncertain.

At present, the general contra-indications for laparoscopy include:

Absolute contra-indications:

  • Hypovolemic shock, massive bleeding or hemodynamic instability.

  • Severe cardio respiratory disease.

  • Uncontrolled coagulopathies.

Relative contra-indications:

  • Peritonitis

  • Portal hypertension

  • Multiple previous procedures/extensive intraabdominal adhesions

The use of laparoscopy in early pregnancy has been recommended in many studies; according to these studies the enlarged uterus and relatively smaller abdominal cavity result in difficulties when performing these procedures in advanced gestation. The risk of penetration of the uterus on the introduction of the Veress needle and trocar has led to the recommendation for insertion the abovementioned device under sonographic control or the use of open technique. An additional concern unique to the laparoscopic surgery is the possibility of high intraabdominal pressure, decreasing venous return and cardiac output, resulting in the reduction of utero-placental blood perfusion. The Trendelenburg position may also aggravate the low lung compliance caused by increasing intraabdominal pressure; furthermore the pneumoperitoneal related complications and injuries to abdominal organs followed by trocar insertion are frequently reported in this procedure. Trendelberg position and operating table left tilt to avoid caval compression can minimize the risk of this complication.

Steinbrook et al. have reported similar cardiovascular effects and hemodynamic changes after CO2 pneumoperitoneum in pregnant and non pregnant patients. In another word, similar decrease in cardiac index, mean arterial pressure and SVR (systemic vascular resistance) is reported after CO2 insufflation in pregnant and non pregnant patients.

It is assumed that maintaining end tidal CO2 pressure (PET CO2) around 32–34 mmHg prevents significant respiratory acidosis during laparoscopic surgery in pregnant patients and as a result, capnography would be adequate to guide ventilation during CO2 insufflation in this group of patients. On the contrary, Cruz et al. reported maternal and fetal acidosis in pregnant ewes when PET CO2 was used to guide ventilation during CO2 insufflation. Repeated ABG has not shown to have more advantages compared with simple capnography because it is shown that an average pneumoperitoneum pressure of 12 or lower is not accompanied by a significant increase in CO2 level in mother or fetus blood and so fetus acidosis would not be a harass.

The fetus normally maintains a mild respiratory acidosis, which facilitates tissue – oxygen delivery by shifting the oxyhemoglobin dissociation curve to the right. It is possible that any increase in maternal CO2, for instance during CO2 pneumoperitoneum, may impair the exchange and as a result, worsens the fetal acidosis. Thus, several studies have suggested routine intraoperative fetal monitoring. On the other hand, some others suggest fetal heart rate evaluation by ultrasound before and after the surgery would be sufficient. It should be noted that transvaginal sonography must be used during the procedure because the signals from abdominal ultrasound would be lost during insufflation. Another concern is that the type of anesthesia might affect the fetus. The majority of the studies have noted general anesthesia to be the anesthetic method of choice in these patients; however, regional anesthesia can be safely used during the first and early second trimester.

There is no evidence to support the routine use of prophylactic tocolytics; however, they have been administered when premature contractions developed after LC.

In addition, using different radiologic techniques in order to confirm the diagnosis of biliary disease and intraoperative cholangiography during the pregnancy is not absolutely contraindicated and could be performed using a shield if necessary. However, in our patients there was no need for performing CT-scan prior to the operation or intraoperative cholangiography for confirming the diagnosis was not required.

Morbidity ranges from 1 to 9% and CBD injuries from 0.2 to 0.7% and they both largely depend on the surgeon’s experience. Conversion rates are from 1.8 to 7.8%. Specific complications include hemorrhage, bile leaks, retained stones, wound infections and incisional hernias.

In general, laparoscopic cholecystectomy has proven to have several advantages upon open surgery; some of the merits are as follows:

  • Shorter hospital stay

  • Less time to resume normal duties

  • Lower pain scores and less use of opioids

  • Sooner return to normal diet

  • Greater patient satisfaction

The key points associated with higher success rate in laparoscopic cholecystectomy during pregnancy:

  • Experienced surgeon

  • Trendelberg and left tilted position

  • Insertion of the first trocar with great precussion especially in late pregnancy to avoid injury of gravid uterus

  • Pneumoperitoneum created with an average intraabdominal pressure of 10–12 mmHg

  • Adequate Mother monitoring (adequate management of anesthetic, adequate hydration of mother to reduce the likelihood of premature labor) and treating the contractions with tocolytics.

  • Conversion to open cholecystectomy should be performed if intraoperative conditions make continued laparoscopic surgery unsafe.

Successful Cholecystectomy During Pregnancy

SAN DIEGO — A pregnant woman successfully delivered twins at term after undergoing laparoscopic cholecystectomy for symptomatic gall bladder disease during the first trimester, Kathy Gohar, M.D., said.

Cholecystectomy is one of the most common nonobstetric surgeries performed during pregnancy, but limited experience with the relatively new laparoscopic approach makes it controversial. About 10%–40% of patients with symptomatic gallstone disease require surgical treatment, said Dr. Gohar of Albert Einstein Medical Center, Philadelphia, and her associates.

Potential advantages of laparoscopic cholecystectomy include less need for narcotics that cause fetal depression, less postoperative pain, shorter hospital stay, a smaller incision, quicker return of bowel activity, and less chance of incisional hernia, compared with open cholecystectomy.

The 24-year-old woman with twins at 17 weeks’ gestation came to the emergency department complaining of 4 days of abdominal pain with nausea and vomiting. She recently had been admitted to a separate hospital for biliary colic and had been treated conservatively with IV hydration, antiemetics, and analgesics. Approximately 60% of patients with symptomatic gallstone disease will require additional hospitalizations after receiving conservative medical management.

The patient had stable vital signs and no fever. Her abdomen was soft with positive bowel sounds and tenderness in the right upper quadrant with deep palpation.

Dr. Gohar and her associates resumed the medical management strategies, but the patient failed oral feeding and continued to have nausea, vomiting, diarrhea, and abdominal pain. An ultrasound exam showed a 19-mm solitary gallstone at the neck of the gall bladder. The common bile duct measured 5.3 mm on imaging, and no pericholecystic fluid or gall bladder wall thickening was observed.

The patient was given preoperative antibiotics and the tocolytic agent indomethacin and taken to the operating room for laparoscopic cholecystectomy. During surgery, her abdominal tissues were fragile and at times bled easily, Dr. Gohar said. Surgeons removed the gall bladder, found it to be filled with mucinous fluid, and diagnosed hydrops of the gall bladder.

After two postoperative days without any intrauterine contractions, the patient was discharged. She developed no complications and subsequently delivered healthy twins at 36 weeks’ gestation.

The ideal time for cholecystectomy during pregnancy is not during the first trimester, as in this case, but in the second trimester. By that time, the woman has passed the time of greatest risk for spontaneous abortion, organogenesis is complete, induction of premature labor is less likely than later in pregnancy, and the uterus is not too large for operative intervention, Dr. Gohar said.

She and her associates followed recommendations in the medical literature for management of gall bladder disease during pregnancy. They obtained a preoperative obstetrical consultation and monitored for uterine contractions before and after surgery. Use of tocolytics is advised from 20 to 32 weeks’ gestation in these cases, she noted.

Surgeons placed the patient in a left anterior oblique position to displace the uterus from the inferior vena cava. They used a pneumoperitoneum compression device, since pregnancy induces a hypercoagulable state and the pneumoperitoneum enhances venous stasis in the lower extremities. Fetal heart monitoring was conducted before and during surgery.

After measuring the uterine fundus height, they inserted the primary trocar via the Hasson technique (at the supraumbilical subxiphoid or left upper quadrant) and inserted the secondary trocars higher than called for in nonpregnant patients. They monitored maternal end-tidal carbon dioxide measurements to indirectly gauge fetal carbon dioxide levels.

If an intraoperative cholangiogram is needed during pregnancy, a lead shield should be employed to protect the gravid uterus, and fluoroscopy should be used selectively, Dr. Gohar added. Patients with enlarged uteri are better candidates for open cholecystectomy than the laparoscopic approach to provide sufficient abdominal access.

Why Are Pregnant Women More Likely to Get Gallstones?

There is a clear correlation between gallstones and pregnancy. If you are a woman, you are 2 – 3 times more likely to have gallstones than men.

In addition, if you are pregnant, you increase that risk even more due to the elevation of estrogen that occurs during pregnancy. Higher levels of estrogen causes a rise in cholesterol which leads to the development of gallstones.

It is important for you to know the symptoms of gallstones so you can recognize when to seek care before this condition becomes a medical emergency.

Functions of the Gallbladder

This tiny storage organ can cause all kinds of complications while you are pregnant. The gallbladder stores bile produced by the liver with the sole purpose of releasing it into the small intestine when our body needs it. This release helps us to digest fat and dairy.

Bile is comprised of cholesterol, bilirubin, and bile salts. If the makeup of bile is not balanced properly, it can create stones and the slowing of gallbladder contractions. For example, too much cholesterol, or too much bilirubin and not enough bile salts can develop gallstones.

Symptoms and Complications of Gallstones During Pregnancy

Not everyone experiences symptoms with gallstones, but if you do, they can be quite serious. The following occurrences are all signs of a gallstone:

  • Severe and continuous pain in the upper right part of the abdomen especially after a fatty meal
  • Intense itching
  • Pain in the upper abdomen which moves into the right shoulder and back
  • Severe abdominal pain lasting more than five hours
  • Nausea and vomiting
  • Fever and chills may be present
  • Yellowing of the skin and whites of the eyes
  • Dark urine
  • Clay colored stools

Seek immediate medical attention with any combination of these symptoms. Gallstones cause inflammation and can develop into cholestasis of pregnancy, and the slowing of gallbladder contractions. This most often occurs due to an insufficient amount of bile release.

Excess hormone production is another common contributor to gallstones. Having too much estrogen in the body increases the amount of cholesterol in our bile, which then begins to trigger cholestasis of pregnancy and additional complications.

How You Can Prevent Gallstones

It is possible to prevent gallstones by controlling the amount of cholesterol in your diet and the amount of weight you gain. Obesity increases your risk to develop gallstones.

Consult with your obstetrician to develop a strategy on the avoidance of excess weight.

Eat lots of high fiber foods and the right fats. Concentrate on monounsaturated fats and omega 3 fats to help prevent stones from forming. Avoid high saturated fats like red meats, dairy, and fried foods.

Cut back on sugar and white flour like pasta, crackers, bread, and chips.

Managing diabetes is essential during pregnancy. Not only will monitoring this condition help reduce your risk for gallstones, but it also provides a wealth of other opportunities in regards to your overall health.

Final Thoughts

It is hard to give up all the foods you crave during pregnancy. Who doesn’t want a juicy cheeseburger, or to sit with a bag of chips at night? Sadly, neither of these choices possess much benefit to you or your little one. Stay focused during this special time by lowering cholesterol intake and preventing gallstones.

See your obstetrician right away if you suspect you may have gallstones, as these are always better to be treated sooner rather than later. To contact a provider at Dedicated to Women OBGYN, please call (302) 674-0223.

Image: Getty Images

There’s never a good time to have gallbladder problems, but having them during pregnancy when you’re already uncomfortable is a double blow. Bile, a substance made by the liver, is stored in the gallbladder. It helps our bodies to digest fats in the small intestines. But if it sits in the gallbladder too long, it takes on a sludge or solid form — the solid bile is also known as a gallstone. This is more common during pregnancy, when the gallbladder is more sluggish at emptying bile, giving it more time to form sludge or stones. Problems occur when the stones block bile from flowing through the organ.

Gallstones are more common during pregnancy because of the increased level of estrogen in the body, noted Dr. Amos Grünebaum, an OB-GYN and professor at Weill Cornell Medicine in New York City.

Cholesterol can also contribute to a pregnant woman’s risk of gallstone development. A 2006 American Association for the Study of Liver Diseases study reports that women with high levels of good cholesterol were less likely to experience gallstones.

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Grünebaum said that excess weight gain during pregnancy can increase cholesterol amounts in our bile, which can cause gallstones.

“When you’re pregnant, your estrogen levels are higher than ever, and estrogen is partly responsible for the increased concentration of cholesterol in the gallbladder,” Grünebaum said.

Image: Getty/Design: Ashley Britton/SheKnows

How do you know if you’re at risk for gallbladder issues during pregnancy? A 2006 study on about 6,200 women who had a gallbladder disease diagnoses upon being discharged from the hospital after delivery between 1987 and 2001 found that 76 percent of women were diagnosed with having gallstones (uncomplicated cholelithiasis), 16 percent had pancreatitis, 9 percent had acute gallbladder inflammation (cholecystitis) and 8 percent experienced a bile duct infection (cholangitis).

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Those researchers determined that risk factors for hospitalization were age, maternal race, being overweight or obese before pregnancy and weight gain during pregnancy. Having higher insulin resistance could be what links having gallstones and high BMI, a 2008 study by the University of Washington found. Overall, being hospitalized for a gallstone-related disease is common during the first year after pregnancy.

Women are twice as likely as men to develop gallstones. A 2003 study on more than 1,300 women found that about 8 percent experienced gallstones. Gallstone risk goes up the more times you are pregnant too.

According to Dr. Amy Stump, a surgeon at University of Maryland Baltimore Washington Medical Center, chemical- and muscular-function changes can last up to five years after delivery, which raises a woman’s chance of developing gallstones during that time.

If not treated, gallstones can cause gallbladder infections and ruptures. Alone, gallstones can produce some pretty unpleasant symptoms as well. Gallbladder attack symptoms include ongoing abdominal pain, vomiting or nausea. Back pain between shoulder blades and pain in the upper right area of the abdomen are also symptoms, the Mayo Clinic reports.

Think you’re having a gallbladder problem? The doctor will usually conduct an ultrasound to diagnose it.

Treatments can vary. Gallbladders that cause issues during pregnancy are usually removed through minimally invasive laparoscopic surgery upon delivery, though it can be performed during any trimester in most cases, a 2014 study in American Family Physician reports.

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“Sounds scary, but this is safe for both Mom and Baby, especially during the second trimester,” Grünebaum said, adding that the gallbladder can be surgically removed safely during your pregnancy as long as gallstones are discovered in the first or second trimester

“Gallstone-related surgery is, after appendicitis, the second-most common no-obstetric surgery done in pregnancy,” he added. “Surgical removal of the gallbladder, usually by laparoscopy, is safe and effective to treat symptomatic gallstones in pregnancy.”

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