Infectious Diseases in Obstetrics and Gynecology 4:303-309 (1996) (C) 1997 Wiley-Liss, Inc. Cholecystitis in Pregnancy Brian M. Casey* and Susan M. Cox Department of Obstetrics and Gynecology, Universily of Texas Southasestern Medical Center, Dallas, Texas ABSTRACT Biliary tract disease is a relatively uncommon, heterogenous disease in pregnancy. Specifical- ly, acute eholecystitis can be especially difficult to recognize in pregnancy. However, once diag- nosed, the initial management plan should be conservative and include antibiotic therapy. Subse- quent management depends on the gestational age at diagnosis. Surgical therapy, when indicated, should not be delayed and a planned intervention during the second trimester appears to offer a better outcome than surgery performed under emergent conditions. Infect. Dis. Obstet. Gyneeol. 4:303-309, 1996. (C) 1997 wiey-I.iss, Inc. KEY WORDS biliary tract disease; cholelithiasis; Escaericaia coli; Bacteroides species holelithiasis is a condition which effects ap- proximately 20 million American women with million new cases diagnosed each year. Women of reproductive age are 4 times more likely than men of similar age to develop gallbladder disease,z Epidemiologic studies indicate that the incidence of cholesterol gallstones rises abruptly as women enter the childbearing years. 3 In fact, several stud- ies show a direct relationship between parity and risk of developing biliary stones. 4-6 Generally though, biliary tract disease is a relatively uncom- mon occurrence during pregnancy. A recent review of more than 45,000 pregnant women revealed the incidence of symptomatic biliary tract disease to be 0.16% in pregnancy. 7 Despite its relatively uncom- mon occurrence during pregnancy, 81% of women with symptoms of gallbladder disease had their first attack within 1 year of pregnancy. Pregnancy then seems to predispose women to developing biliary tract disease. Biliary tract disease encompasses a continuum of pathologic entities which includes biliary sludg- ing, cholelithiasis, cholecystitis, choledocholithia- sis, and cholangitis. Biliary sludge or the supersatu- ration of bile with cholesterol, is an important pre- cursor to gallstone formation. The exact prevalence of cholelithiasis in pregnancy is essentially un- known since 50% of women with gallstones are asymptomatic. Efforts to identify asymptomatic cholelithiasis in pregnancy using ultrasound have produced variable results; however, the best esti- mate of incidence appears to be between 2.5% and 4.5%. 8-1o In addition to pregnancy, several other factors are strongly associated with gallbladder disease. Ethnicity contributes to the risk for developing bil- iary disease. In particular, 70% of Native American women older than 30 years of age develop choleli- thiasis. Mexican American women have an inter- mediate prevalence of about 14% with Caucasians and Black women at 4% and 5%, respectively. 1 Chilean women are also reported to be at high risk for developing gallstones. e In addition, heredity has been implicated as a contributing factor; 20% of first degree relatives with cholelithiasis will de- velop symptomatic gallstones. 1 Finally, age and obesity are also commonly associated with biliary disease. *Correspondence to: Dr. Brian M. Casey, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235-9032. Review Article Received 10 July 1996 Accepted November 1996