Choledocholithiasis in Pregnancy: Treatment Approach
Choledocholithiasis — bile duct stones — may occur during pregnancy, creating a situation where effective stone management must be balanced carefully against fetal safety considerations.
Clinical Scenario
Pregnancy
The patient is pregnant. The presence of common bile duct stones during pregnancy introduces constraints on intervention timing and technique that differ substantially from the standard approach in non-pregnant patients.
Treatment Approach
Management centres on an endoscopic procedure performed with specific timing and radiation-minimisation adaptations to protect the fetus.
Full procedural details — including timing, alternative techniques, and guidance modalities — are in the complete protocol.
References
- Choledocholithiasis may occur during pregnancy.
- ERCP is recommended to be performed starting in the second trimester because organogenesis is still present during the first trimester, hence risking abnormalities with radioactive exposure.
- The radiation may also be given at a relatively smaller dose at 10 mGy to minimize its effects on the fetus.
- Guidance using ultrasound and cholangioscopy are also used to minimize the effects of radiation.
- Recently, ERCP without fluoroscopy has also been attempted in order to reduce the radiation exposure, with similar technical success as conventional ERCP.
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