Pregnancy creates the perfect biological storm for gallstone formation: rising oestrogen increases cholesterol secretion into bile, while progesterone slows gallbladder emptying. By the third trimester roughly 1 in 10 pregnant women have detectable gallstones on ultrasound, and around 1 in 100 will have a symptomatic attack during pregnancy. Many women are understandably anxious about being investigated or operated on while pregnant — but with the right specialist team, gallstones in pregnancy can be managed safely for both mother and baby. As a female specialist laparoscopic surgeon at Medcare Hospital Al Safa, Dr. Vanesha Varik regularly co-manages these patients with the obstetrics team, and writes this guide for women in Dubai who want to understand their options.
Why pregnancy increases gallstone risk
Two hormonal changes drive the increase:
- •Oestrogen raises the cholesterol content of bile, making it more lithogenic (more likely to form stones).
- •Progesterone relaxes smooth muscle, slowing gallbladder emptying. Stagnant bile crystallises more readily.
Add the typical weight gain, dietary changes and reduced activity of pregnancy and the gallbladder is under unusual strain. The risk continues for several months postpartum and is further increased by rapid postpartum weight loss.
Symptoms to recognise
- •Severe right upper or central abdominal pain after meals
- •Nausea and vomiting
- •Pain radiating to the right shoulder or back
- •Fever or chills (suggests infection — emergency)
- •Yellowing of the eyes or skin (suggests bile duct obstruction — emergency)
Any of these symptoms in pregnancy require same-day medical assessment, ideally by an obstetric and surgical team together.
Investigations that are safe in pregnancy
1. Abdominal ultrasound — completely safe, first-line, accurate for gallstones and ductal dilation. 2. MRCP (without contrast) — safe in 2nd and 3rd trimester for suspected bile duct stones. 3. Blood tests — liver function, inflammatory markers. Avoided where possible: CT scan (radiation) and ERCP (radiation, sedation risk) — used only when essential.
Conservative management
Most first attacks settle with:
- •IV fluids and bowel rest
- •Paracetamol-based analgesia (and short course of opioid if needed; NSAIDs avoided in 3rd trimester)
- •Anti-emetics safe in pregnancy (ondansetron, metoclopramide)
- •Low-fat diet on discharge Approximately half of patients have no further attacks during the rest of the pregnancy.
When surgery is needed during pregnancy
Indications include:
- •Recurrent attacks of biliary colic
- •Acute cholecystitis not settling with antibiotics
- •Bile duct stones causing jaundice or pancreatitis
- •Inability to maintain nutrition due to symptoms
Laparoscopic cholecystectomy is the operation of choice. The 2nd trimester (weeks 13–26) is the safest window — organogenesis complete, uterus not yet too large to obstruct laparoscopic view, lowest risk of preterm labour.
How surgery is adapted for pregnancy
- •Tilted left-lateral position to relieve pressure on the inferior vena cava
- •Lower CO2 pressures during pneumoperitoneum
- •Open (Hasson) port insertion to avoid uterine injury
- •Foetal monitoring before and after surgery
- •Joint anaesthetic plan with obstetric anaesthesiology
Modern data show foetal loss rates with laparoscopic cholecystectomy in pregnancy are very low — under 1% in the 2nd trimester, comparable to background rates.
Postpartum management
If symptoms can be safely managed conservatively until delivery, surgery is typically performed 6–12 weeks postpartum. This avoids the uncertainties of operating during pregnancy. Breastfeeding is fully compatible with surgery and standard analgesia.