Acute Cholecystitis in Pregnancy: A Review of Incidence, Risk Factors, Diagnostic Challenges, Management, and Maternal-Fetal Outcomes.

Background and

Objectives

Acute cholecystitis occurs in approximately 0.3-0.6% of pregnant women and may pose significant risks to both the mother and the fetus. The condition is most commonly caused by gallstone-induced obstruction of the cystic duct, with pregnancy-related hormonal and physiological changes contributing to its development. The aim of this review was to summarize current evidence on the pathogenesis, diagnostic challenges, and management of acute cholecystitis during pregnancy, as well as to evaluate associated maternal and fetal outcomes. Materials and

Methods

This study was conducted as a structured narrative review incorporating elements of a systematic literature search. A comprehensive search was performed in PubMed (MEDLINE), with additional sources identified through Google Scholar. Articles published between 2015 and 2025 were included. Eligible studies addressed pathogenesis, risk factors, diagnosis, management, or maternal and fetal outcomes. A total of 55 studies were included and analyzed qualitatively.

Results

Acute cholecystitis during pregnancy presents diagnostic challenges due to nonspecific symptoms that may overlap with normal pregnancy-related conditions. Ultrasound remains the first-line imaging modality. Conservative management is associated with high recurrence and rehospitalization rates, as well as increased risks of adverse fetal outcomes, including preterm delivery, fetal growth restriction, and low birth weight. In contrast, laparoscopic cholecystectomy is associated with lower complication rates and improved outcomes, and can be safely performed during all trimesters when clinically indicated.

Conclusions

Acute cholecystitis during pregnancy requires careful clinical evaluation and individualized management. Current evidence suggests that laparoscopic cholecystectomy is a safe and effective treatment option, and is widely considered the preferred approach in most cases. Conservative management may be appropriate in selected mild cases but is associated with a higher risk of recurrence and adverse outcomes.