Acute biliary colic: How to proceed before, during and after pregnancy

There is a high incidence of gallstones (up to 12%) and sludge (up to 30%) in pregnant women due to the lithogenic effect of increasing estrogen and progesterone levels throughout pregnancy. Symptomatic gallstone-related disease, which is believed to occur in 1–3% of affected women, is associated with a relevant risk for morbidity and consequently mortality concerning the expectant mothers and their fetuses requiring challenging diagnostic and therapeutic decisions from the involved physicians (gastroenterologists, obstetricians, surgeons). Supportive drug therapy for symptomatic gallstone disease does not substantially differ from that initiated in non-pregnant patients. Risk categories of the Food and Drug Administration (FDA) for drug therapy in pregnancy as well as the online platform embryotox.de represent valuable tools for choosing the appropriate medication. Current studies demonstrate a high relapse and progression rate of symptomatic cholelithiasis managed conservatively. In addition, some studies showed a higher rate of preterm deliveries and induction of labor associated with conservative treatment compared to surgical therapy. Therefore there is a growing consensus favouring an early laparoscopic cholecystectomy for symptomatic gallstone disease, preferably within the second trimester.