Outcomes of Gallstone Disease during Pregnancy: a Population‐based Data Linkage Study

Ibiebele, Ibinabo; Schnitzler, Margaret; Nippita, Tanya A.; Ford, Jane B.

doi:10.1111/ppe.12406

Cited by 38 publications

(46 citation statements)

References 22 publications

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“…Physiologic changes during pregnancy increase the risk of gallstones. These changes include decreased gallbladder contractility due to increased progesterone levels, which leads to increased gallbladder volume and, ultimately, stasis and impaired gallbladder emptying . This biliary stasis promotes the formation of biliary sludge, a precursor to gallstone formation …”

Section: Special Considerations In Pregnancymentioning

confidence: 99%

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Cholelithiasis: Presentation and Management

Littlefield

Lenahan

2019

J Midwife Womens Health

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Cholelithiasis affects approximately 15% of the US population. Rising trends in obesity and metabolic syndrome have contributed to an increase in diagnosis of cholelithiasis. There are several risk factors for cholelithiasis, both modifiable and nonmodifiable. Women are more likely to experience cholelithiasis than are men. Pregnancy, increasing parity, and obesity during pregnancy further increase the risk that a woman will develop cholelithiasis. The classic presentation of persons experiencing cholelithiasis, specifically when gallstones obstruct the common bile duct, is right upper quadrant pain of the abdomen that is often elicited upon palpation during physical examination and documented as a positive Murphy's sign. Referred pain to the right supraclavicular region and/or shoulder, nausea, and vomiting are also frequently reported by persons with cholelithiasis. Cholelithiasis can result in complications, including cholecystitis (inflammation of the gallbladder) and cholangitis (inflammation of the bile duct). Lack of physical examination findings does not rule out a diagnosis of cholelithiasis. Laboratory tests such as white blood cell count, liver enzymes, amylase, and lipase may assist the clinician in diagnosing cholelithiasis; however, ultrasonography is the gold standard for diagnosis. Management is dependent on severity and frequency of symptoms. Lifestyle and dietary modifications combined with medication management, such as use of gallstone dissolution agents, may be recommended for persons who have a single symptomatic episode. If symptoms become severe and/or are recurrent, laparoscopic cholecystectomy is recommended. It is recommended that individuals with an established diagnosis of cholelithiasis be referred to a surgeon and/or gastroenterologist within 2 weeks of initial presentation regardless of severity or frequency of symptoms.

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Section: Special Considerations In Pregnancymentioning

confidence: 99%

“…The risk of gallstone formation in pregnancy is most prevalent in the second and third trimesters . The incidence of gallstone formation increases with parity: 5.1% after the first pregnancy, 7.6% after 2 pregnancies, and 12.3% after 3 or more pregnancies .…”

Section: Special Considerations In Pregnancymentioning

confidence: 99%

Cholelithiasis: Presentation and Management

Littlefield

Lenahan

2019

J Midwife Womens Health

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“…Definitive surgery is preferable during the index admission for biliary colic and cholecystitis to reduce the risk of recurrent symptoms and complications. Gallstone disease has been shown to increase the risk of maternal readmission by 4.7 times, with surgery reducing the risk to just 0.4 times greater than those without gallstone disease during pregnancy . However, in practice, local service capacity influences such a pathway.…”

Section: Surgical Conditionsmentioning

confidence: 99%

“…Gallstone disease has been shown to increase the risk of maternal readmission by 4.7 times, with surgery reducing the risk to just 0.4 times greater than those without gallstone disease during pregnancy. 30 However, in practice, local service capacity influences such a pathway.…”

Section: Biliary Colic/cholecystitismentioning

confidence: 99%

Surgical causes of acute abdominal pain in pregnancy

Woodhead

Nkwam

Caddick

et al. 2019

The Obstetric & Gynaecologis

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Key content Abdominal pain in pregnancy is common, with a differential diagnosis that can encompass obstetric, surgical and medical conditions. Presentation of common surgical problems can be atypical in pregnancy, potentially delaying diagnosis. Surgical causes of abdominal pain to consider in pregnancy include appendicitis, cholecystitis, bowel obstruction, ureteric obstruction, pancreatitis and aneurysm rupture, most commonly involving the splenic artery. The management of surgical conditions in pregnancy requires continuing evaluation and potential modification to balance the medical, surgical and obstetric challenges. Management of the pregnant woman with a surgical cause of abdominal pain requires collaborative, multispecialty practice to optimise care of the mother and baby. Learning objectives To highlight the differential diagnoses of abdominal pain in pregnancy. To develop a structured assessment process for pregnant women with abdominal pain. To update the obstetrician on the priorities of surgical management for abdominal pain in pregnancy. Ethical issues Evaluating the risks of surgical interventions on the mother and baby with the high potential for premature delivery.

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“…Surgical complication rates are similar when compared with non-pregnant patients,11 and laparoscopic surgery appears to be safe in all stages of pregnancy 12. Conversely, conservative management of biliary disease in pregnancy is associated with adverse maternal and fetal outcomes,13 14 and can increase the risk of delivery by caesarean section 15…”

Section: Introductionmentioning

confidence: 99%