Gall bladder disease complicating pregnancy

Gallbladder and pancreatic disease during pregnancy

Gallbladder disease and pancreatitis are two nonobstetric abdominal-related complaints presenting during pregnancy; gallbladder-related surgery in pregnancy is second only to appendectomy. Pancreatitis is seen less often but its most common cause is gallstone-related pain. The purpose of this manuscript is to review the clinical assessment and management of these disorders in pregnancy and to make nurses aware of the most current clinical options and techniques.

Disease of the gallbladder and pancreas in pregnancy

Although maternal mortality and morbidity are substantially lower today than decades ago, perinatal mortality and morbidity secondary to gallbladder and pancreatic disease remain excessive. Improvements in perinatal mortality reflect improvements in neonatal intensive care because most of the morbidity stems from prematurity. Prompt recognition of cholelithiasis and pancreatitis and liberal hospitalization have been associated with a decline in poor outcomes. The decision to switch from medical to surgical management must be made individually, taking into account past history, gestational age, and the response of current disease to conservative therapy.

Laparoscopic cholecystectomy in pregnancy

It has been stated that pregnancy is an absolute contraindication to laparoscopic cholecystectomy. After failed medical management, five gravid patients underwent successful laparoscopic cholecystectomy with single-film intraoperative cholangiography. One patient was in the first trimester, three were in the second trimester, and one was in the third trimester. All carried the pregnancy to term and delivered normal children. Laparoscopic cholecystectomy can be safely performed during pregnancy and offers the potential of significant cost savings compared with traditional medical management of cholecystitis complicating pregnancy.