Management of gallstones in pregnancy

 

Management of  gallstones in pregnancy

 

More than half of gallstone patients are women, you may have this problem during pregnancy, but do not worry, gallstones in pregnancy with treatment and timely intervention, will not harm the fetus and yourself.

Our doctors explain more about the management of gallstone in pregnancy.

 

What is a gallbladder and where is it located?

Why do gallstones form?

Symptoms of gallstones in pregnancy

Types of gallbladder and gallbladder problems in pregnancy

Treatment

How are gallstones managed during pregnancy?

Prevention of gallstones in pregnancy

 

 

What is a gallbladder and where is it located?

The gallbladder is a small organ in the lower part of the liver. Inside this organ, a fluid called bile is made, which is poured into the small intestine through a special duct and causes the digestion of fats in the food consumed.

For whatever reason, if bile stays in the sac and moves, it thickens and hardens to form gallstones.

This stone can get stuck in the duct and cause inflammation, pain and infection

 

 

Why do gallstones form?

During pregnancy, there are conditions in the body of a pregnant woman that increase the possibility of gallstones.

Factors affecting the formation of gallstones in pregnancy are:

  • Female hormones:

Estrogen is high in pregnancy and increases cholesterol levels. Decreasing progesterone is also associated with slowing down the rate of bile excretion.

  • Weight gain:

Overweight in pregnancy, which is associated with increased fat accumulation, causes more estrogen production, so maintaining a balanced weight during pregnancy is essential.

  • Gestational diabetes:

In general, diabetes is associated with gallbladder and gallbladder problems. Women with gestational diabetes are more prone to slowing down gallbladder emptying and stone formation.

Family history and type of diet during pregnancy can also be involved in gallstone formation and gall problems.

 

 

Symptoms of gallstones in pregnancy

Signs and symptoms of gallstone and bile problems in pregnancy include the following:

  • the pain:

Biliary pain is a sharp, contractile, and sometimes diffuse pain. The pain may be severe or vague:

  • Yellowing of the eyes and skin
  • Decreased appetite
  • Darkening of the urine
  • Stool lightening
  • Fatigue

 

 

Types of gallbladder and gallbladder problems in pregnancy

These problems can be divided into the following:

  • Gallstones:

Insufficient bile salts or high cholesterol can increase the risk of gallstones. This problem is exacerbated when the emptying of the gallbladder slows down for any reason, for example due to a decrease in the hormone progesterone in pregnancy.

Inflammation of the gallbladder or cholecystitis occurs following slowness and failure to empty the gallbladder.

Cholecystitis is an inflammation of the gallbladder that often follows lithiasis or gallstones.

Symptoms of cholecystitis include:

 

  • Symptoms of acute cholecystitis:
  • Severe abdominal pain
  • Ague
  • jaundice
  • Vomit

 

  • Symptoms of non-acute cholecystitis:

These chronic pains occur in the upper right part of the abdomen and often last for hours and spread to the back and right shoulder. Occasionally there is nausea and vomiting, and most people develop these symptoms after eating a heavy meal of high-fat food.

High estrogen and low progesterone in pregnancy lead to gallstones in pregnant women and inflammation of the gallbladder and cystitis occurs when the gallbladder outlet is closed.

 

 

Treatment

Gallbladder resection, which is called cholecystectomy, is the treatment for gallstones and acute cholecystitis. Cholecystectomy is performed in two ways:

  • Open:

The person's abdomen is cut after anesthesia and the gallbladder is removed

  • Laparoscopic:

It is performed without general anesthesia and without opening the abdomen

In pregnant women, laparoscopic cholecystectomy is the treatment for cholecystitis and gallstones at any month of pregnancy.

It is interesting to know that this operation is the second cause of surgery in pregnant women (with non-obstetric causes).

The first common surgery is to remove an inflamed appendix or appendectomy

  • Colstase:

Slow gallbladder contractions in pregnancy are caused by changes in hormones, especially progesterone. Slow drainage of bile causes bile stasis inside the gallbladder or cholestasis.

Pregnancy cholestasis can cause severe itchy skin in pregnant women.

 

Doctors may prescribe the following medications to relieve skin itching caused by cholestasis of pregnancy:

  • Ursodiol (actigall) (Ursa)
  • Ursodeoxycholic acid or INN or BAN or AAN

At home, you can use a warm bath (not hot) or apply a cold compress to reduce itching.

The use of antihistamines and corticosteroids to reduce itching due to hepatic cholestasis is dangerous and harms the fetus.

If the fetus is damaged by cholestasis of pregnancy, termination of pregnancy at the end of thirty-seven weeks is mandatory. Cholestasis can cause serious complications for pregnancy.

 

 

How are gallstones managed during pregnancy?

If you are pregnant and have gallstones and your doctor does not find you have severe symptoms, he or she will monitor you, which is called watchful waiting.

This means that as long as you do not have serious symptoms, you will not need medical intervention unless you have a serious complication.

 

This complication is the same as acute cholecystitis, during which there is a risk of spreading inflammation and infection throughout your body, so removal of the gallbladder or cholecystectomy is necessary. Surgery is not performed during pregnancy unless life-threatening conditions have occurred.

Removal of the gallbladder, the outlet of which is blocked and inflamed by gallstones, is selectively performed by laparoscopic surgery during pregnancy. In this method, the pregnant woman does not receive general anesthesia.

 

Several small holes are made in the abdominal wall and through these holes the laparoscope, which is equipped with cameras and surgical instruments are installed on their heads, enters the safe space above the abdomen and the inflamed gallbladder leaves the body without a knife and direct intervention of the surgeon.

 

 

Prevention of gallstones in pregnancy

You can for prevention:

  • Eat healthy foods during pregnancy and avoid fatty and heavy foods.
  • Get enough mobility
  • Drink enough
  • About one-half to two-thirds of women who have experienced cholestasis in one pregnancy will develop cholestasis again in their next pregnancy.
  • Pregnancy cholestasis can cause very serious complications, so be sure to tell your doctor at the first suspicious sign.

 

If your doctor approves, you can also use the following to reduce gallstone pain:

  • Hot compress
  • Turmeric
  • Apple cider vinegar
  • Magnesium supplements
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