Pregnant patient with imaging demonstrating gallstones

HELLP: Hemolysis, Elevated Liver enzymes, Low Platelet count; ERCP: endoscopic retrograde cholangiopancreatography; AST: aspartate aminotransferase; ALT: alanine aminotransferase; CBC: complete blood count.
* Laboratory evaluation is usually normal in patients with uncomplicated gallstone disease; abnormal laboratory tests suggest the development of complicated gallstone disease or other pregnancy- or non-pregnancy-related conditions. We perform the following baseline evaluation:

• AST/ALT, total bilirubin, alkaline phosphatase (to evaluate for complicated gallstone disease, HELLP, and preeclampsia)
• Serum amylase and lipase (to evaluate for pancreatitis)
• CBC (to evaluate for infection, HELLP, and preeclampsia)
• Urine protein (to evaluate for preeclampsia)

¶ Laparoscopic cholecystectomy is the preferred technique for removal of the gallbladder in pregnant patients and can be performed during any trimester.
Δ An alternative approach for those near term is to delay cholecystectomy until the postpartum period as long as the presenting symptoms have been adequately addressed by nonsurgical methods (eg, supportive treatment for gallstone pancreatitis, ERCP for choledocholithiasis or cholangitis).
◊ Some of our contributors do not delay surgery until the postpartum period and rather offer cholecystectomy to all patients with biliary colic (even if only a single episode).