A review of the management of gallstone disease and its complications in pregnancy

Date, Ravindra; Kaushal, Mishi; Ananthakrishnan, Ramesh

doi:10.1016/j.amjsurg.2008.01.015

Cited by 177 publications

(153 citation statements)

References 53 publications

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“…Th e development of gallstone pancreatitis portends a high rate (10-60%) of fetal demise. Th us, early surgical intervention with laparoscopic cholecystectomy aft er ERCP is preferred ( 21,22 ). One recent study of 9,714 women who underwent cholecystectomy while pregnant, reported longer length of stay than non-pregnant women and maternal and fetal complication rates of 4.3% and 5.8%, respectively ( 23 ).…”

Section: Recommendationsmentioning

confidence: 99%

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

242

257

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Consultation for liver disease in pregnant women is a common and oftentimes vexing clinical consultation for the gastroenterologist. The challenge lies in the need to consider the safety of both the expectant mother and the unborn fetus in the clinical management decisions. This practice guideline provides an evidence-based approach to common diagnostic and treatment challenges of liver disease in pregnant women. Am J Gastroenterol 2016; 111:176-194; doi: 10.1038/ajg.2015 Initial evaluation of pregnant patientA pregnant patient presenting with abnormal liver tests should undergo standard workup as with any non-pregnant individual (strong recommendation, very low level of evidence). Imaging in pregnancyUltrasound is safe and the preferred imaging modality used in assessment of abnormal liver tests suggestive of biliary tract disease (strong recommendation, low level of evidence).Magnetic resonance imaging without gadolinium can be used in the second and third trimester (conditional recommendation, low level of evidence).Computed tomography scans carry a risk of teratogenesis and childhood hematologic malignancies but may be used judiciously with minimized radiation protocols (2-5 rads; conditional recommendation, very low level of evidence). Endoscopy in pregnancyEndoscopy is safe in pregnancy but should be deferred until the second trimester if possible (strong recommendation, low level of evidence).Meperidine and propofol can be used for endoscopic sedation (strong recommendation, moderate level of evidence). Management of biliary disease in pregnancyERCP can be performed when indicated for pregnant women presenting with biliary disease that strongly necessitates intervention such as biliary pancreatitis, symptomatic choledocholithiasis, and/or cholangitis. Minimizing fetal exposure to fl uoroscopy is imperative (strong recommendation, low level of evidence).Symptomatic cholecystitis should be managed with early surgical intervention with laparoscopic cholecystectomy (strong recommendation, low level of evidence). Liver masses in pregnancyAsymptomatic hemangioma and focal nodular hyperplasia do not need routine imaging or surveillance during pregnancy (strong recommendation, very low level evidence).Hepatic adenomas should be monitored with ultrasound during pregnancy for growth. Patients with large adenomas (>5 cm) should be referred for resection prior to pregnancy (strong recommendation, low level of evidence). Hepatitis B in pregnancyActive-passive immunoprophylaxis with hepatitis B immunoglobulin and the HBV vaccination series should be administered to all infants born to HBV-infected mothers to prevent perinatal transmission (strong recommendation, low level of evidence).Women chronically infected with HBV and high viral load (>10 6 log copies/ml (200,000 IU/ml) and higher) should be offered antiviral medication with tenofovir or telbivudine in the third trimester to reduce perinatal transmission of HBV (strong recommendation, low level of evidence).C-section should not be performed electively in HBV-pos...

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Section: Recommendationsmentioning

confidence: 99%

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

242

257

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“…1 Talið er að allt að 12% þungaðra kvenna hafi gallsteina hverju sinni og að um 0,8% þeirra geti þurft að leggjast inn á spítala vegna gallsteinasjúkdóms. [2][3][4] Alvarlegir gallsteinasjúkdómar hjá þunguðum konum á borð við bráða gallblöðrubólgu, gallgangabólgu (cholangitis) og gallsteina-brisbólgu eru hins vegar sjaldgaefir með tíðni á bilinu 0,01-0,05%. 5 Gallblöðrutaka ásamt botnlangatöku eru algengustu skurðaðgerðirnar sem framkvaemdar eru á þunguðum konum, ótengdar meðgöngu (non-obstetrical operations).…”

Section: Inngangurunclassified

“…7 Ókostir þeirrar meðferðar er hins vegar aukin tíðni sjúk-dómsendurkomu sem er algengari því fyrr sem konur greinast á meðgöngu. 4,[8][9][10][11][12] Þá hafa rannsóknir sýnt yfir 20% tíðni bráðrar Inngangur: Gallblöðrutaka um kviðsjá er talin örugg aðgerð á meðgöngu, óháð meðgöngulengd. Ekki er vitað hver kjörmeðferð er við gallsteinasjúkdómum hjá þunguðum konum.…”

Section: Inngangurunclassified

“…4,13,14 Gallblöðrutaka um kviðsjá er talin örugg aðgerð á meðgöngu en samkvaemt leiðbeiningum Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) frá 2011 er maelt með að þung-aðar konur sem greinast með gallsteinasjúkdóma á meðgöngu séu teknar til aðgerðar, óháð meðgöngulengd. 4,15 Á Íslandi hefur ekki áður verið gerð samantekt á afdrifum þeirra kvenna sem greinst hafa með gallsteinasjúkdóm á með-göngu. Tilgangur rannsóknarinnar var því að kanna einkenni, greiningu, meðferð og afdrif þeirra kvenna sem greindust með gallsteina á meðgöngu á Landspítala.…”

Section: á G R I Punclassified

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Gallsteinasjúkdómar hjá þunguðum konum á Landspítala 1990-2010

Kolbeinsson¹,

Harðardóttir²,

Birgisson³

et al. 2016

LBL

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“…Moreover, 40-92% of patients had readmission because of recurrence of symptoms [14][15][16]. Then, early LC is preferred, as results of maternal and fetal morbidity and mortality including the risk of preterm labor do not increase comparing with delayed LC after conservative treatment [17,18].…”

Section: Laparoscopic Cholecystectomy In Pregnant Patientsmentioning

confidence: 99%

Laparoscopic Cholecystectomy in Special Situations

Phothong¹,

Trakarnsanga²

2017

Updates in Gallbladder Diseases

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Gallstone disease is one of the common diseases. Laparoscopic cholecystectomy is the routine surgical treatment. However, the optimal timing and safety to perform this operation are still debated, especially in exceptional situations of each patient. In this chapter, we have collected data from many literatures to summarize the role of laparoscopic cholecystectomy in special situations that are in patients with pregnancy, cirrhosis, diagnosis of acute cholecystitis, and situs inversus.

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A review of the management of gallstone disease and its complications in pregnancy

Cited by 177 publications

References 53 publications

ACG Clinical Guideline: Liver Disease and Pregnancy

ACG Clinical Guideline: Liver Disease and Pregnancy

Gallsteinasjúkdómar hjá þunguðum konum á Landspítala 1990-2010

Laparoscopic Cholecystectomy in Special Situations

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