Hasanov MUSHVIQ, Sevinç QARAYEVA, Konul QARAYEVA, Shamama BEHZAD, Erkut ATTAR
Anatolian Journal of Obstetrics and Gynecology Research - 2026;3(1):29-32
Purpose: Biliary tract disease is one of the most common non-obstetric surgical conditions during pregnancy, affecting up to 12% of pregnant women. Gallstone formation is driven by hormonal changes; estrogen increases hepatic cholesterol secretion into bile while progesterone reduces gallbladder contractility, creating optimal conditions for stone development. These mechanisms peak in the second trimester, establishing it as the period of highest lithogenic risk. Methods: This retrospective observational case series from Azerbaijan Medical University included 25 pregnant women with chronic biliary pathology. Twenty-two patients were managed conservatively with dietary modification, antispasmodics, and ademetionine 800 mg/day. Three patients (12%) underwent urgent laparoscopic cholecystectomy for refractory biliary obstruction confirmed on ultrasound. Liver function tests [aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), bilirubin, cholesterol] were monitored serially each trimester. Results: Exacerbations occurred predominantly in the second trimester (48%) and third trimester (52%). Biochemical markers showed the most pronounced elevations in the second trimester: AST +23%, ALT +24%, ALP +19%, cholesterol +18%, and total bilirubin +68% above trimester-specific reference values. Third trimester showed partial improvement in some markers, although AST and ALP remained elevated. All three surgical patients underwent laparoscopic cholecystectomy with CO2 pneumoperitoneum at 10-14 mmHg, using modified positioning to minimize uterine compression. Mean operative time was 25 minutes with no conversions to open surgery. Clinical improvement occurred within 48 hours, with discharge by postoperative day 4. No perinatal complications or congenital anomalies were reported. Conclusion: Findings support current SAGES guidelines recommending laparoscopic cholecystectomy as the preferred surgical approach when indicated during pregnancy. However, the study has significant limitations: small sample size (especially the surgical subgroup of three patients), retrospective design, incomplete parity data, absence of a control group, and lack of formal analysis of ademetionine efficacy. Results should be interpreted as preliminary observational data requiring confirmation in larger prospective studies.
