Cholecystitis in Pregnancy

Understand cholecystitis in pregnancy

Cholecystitis is an inflammation of the gallbladder, the small organ on the right side of your abdomen underneath your liver that's responsible for storing bile, a yellow-green fluid that helps to digest fat. This liquid is produced by the liver and then stored in the gallbladder. Continue reading to learn about cholecystitis in pregnancy.

In a large percentage of cases, cholecystitis is caused by a blockage of gallstones in the tube that leads from your gallbladder. This causes the bile to build up and create inflammation. Untreated, cholecystitis can lead to life threatening conditions and can be especially dangerous when it occurs in pregnant women.

Cholecystitis in Pregnancy

Obstetric cholestasis generally occurs in the later stages of pregnancy, typically during the last trimester. The term cholestasis is taken from the Greek word "chole" or bile and "stasis" meaning still. This condition happens when bile cannot be excreted properly. Cholestasis in pregnancy is referred to as intrahepatic cholestasis, which refers to the body having difficulties eliminating bile salts from the liver.

While there is no long-term risk to the mother, it does endanger a developing baby and doctors will generally recommend an early delivery. Though gallstones (cholelithiasis) aren't necessarily common during pregnancy, they tend to be more prevalent during pregnancy and childbearing years than at other times.

Cholelithiasis does affect a large number of women, approximately 20 million women, with 1 million new cases every year. This incidence tends to rise as women enter their childbearing years. Ethnicity also factors in, with 70% of Native American women over the age of 30 developing cholelithiasis, 14% of Mexican American women, 5% African American, and 4% Caucasian.

Causes of Cholecystitis in Pregnancy

Pregnancy can cause your gallbladder's motility to decrease, most likely due to elevated progesterone levels, although evidence of this is considered circumstantial. It can also create an increase in cholesterol saturation of bile. In the second and third trimesters, gallbladder volume is increased. These factors together create an increase in biliary stones. It's also thought that the hormones that occur in pregnancy, particularly additional estrogen, can affect the functioning of the gallbladder and liver.

In certain cases, cholecystitis can be caused by trauma or injury to the abdomen or an infection in the bile that creates inflammation in the gallbladder. If there is a genetic predisposition to developing gallstones, the likelihood of a woman contracting cholecystitis in pregnancy increases dramatically. Gallbladder disease is, in fact, the second most common abdominal emergency in pregnant women.

There are also certain conditions that can increase the risk of contracting cholecystitis:

  • Obesity or rapid weight gain
  • Sudden weight loss
  • Crohn's disease
  • Diabetes
  • Hyperlipidemia (the presence of excess lipids or fat in the blood)
  • Genetic predisposition (family history of gallstones particularly on the mother's side)
  • Carrying multiple babies, i.e. twins or triplets
  • Having had cholecystitis in a previous pregnancy
  • Pregnancy from in-vitro fertilization

Symptoms of Cholecystitis in Pregnancy

  • Intense itching, predominantly on palms of hands or soles of feet (generally worse at night)
  • Nausea
  • Loss of appetite
  • Jaundice or yellowing of skin, tongue, and whites of eyes
  • Pain in abdomen area, generally in the upper right but the pain can also extend towards the back and right shoulder blade
  • Increase in intensity of pain when breathing
  • Pain lasts for longer than six hours and comes on after eating a large or fatty meal
  • Fever
  • Darkened urine
  • Light-colored feces
  • Problems absorbing fat soluble vitamins such as vitamins A, D, E and K.

Diagnosis and Treatment of Cholecystitis in Pregnancy

Pregnant women who have any of the above signs should alert their physician immediately to lower any risk to their unborn baby. Physicians will usually take a blood test to determine how well the mother's liver is functioning and to measure levels of bile in the blood. Ultrasound scans may also be done to determine the functioning of the mother's liver.

Physicians will generally treat acute cholecystitis through either medication or surgery. Initial medical therapy usually involves some form of antibiotics and creams to relieve the itching. In severe cases, the gallbladder may need to be removed, although this is less common. Some home remedies include soaking skin in lukewarm water, and applying baking soda, apple cider vinegar or coconut oil to the affected areas. Vitamin K levels in expectant mothers with cholecystitis tend to be low, so a supplement will usually be given before and after delivery.

Problems with cholecystitis in pregnancy usually decrease within a few days after giving birth, although there is a higher incidence of pre-term birth when cholecystitis is present. Also, if too much bile acid is present in the mother's body, this can be passed onto the fetus. In the event of this, physicians will usually recommend early induced labor (generally at 38 weeks) to avoid serious complications to the fetus.

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Last Reviewed:
July 25, 2017
Last Updated:
October 24, 2017
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