One of the most common abdominal emergencies in pregnant women is symptomatic gallstones. Patients present to the emergency room with abdominal pain and jaundice. Using an abdominal ultrasound the physician will usually find a dilated common bile duct and gallstones. Concerns regarding the fetus have in the past prevented some of the routine treatments in the management of this disease.
Several studies in the last few years have shown that there were not significant differences in the incidence of preterm delivery when comparing conservative management with surgical management of the cholecystitis. Studies looking at the use of laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) did not show maternal or fetal mortality when performed with necessary precautions. Laparoscopic cholecystectomy was also found to be safe in all trimesters. One finding of concern was that in reports of gallstone pancreatitis there was a significant increase in fetal mortality when mothers were treated conservatively compared to those receiving surgical intervention which suggests the need for earlier surgical intervention.
In a study looking at the safety and efficacy of the use of ERCP a review of the records of women treated between 1996-2005 found that the use of biliary sphincerotomy and placement of a stent without the use of fluoroscopy followed by an ERCP with stone removal after delivery was an effective approach which avoided radiation exposure to the fetus. Patients showed a relief of pain and symptoms after the first phase of treatment. In two patients the stone were large enough that they were unable to be removed by ERCP and required lithotripsy in one patient and surgery in another with good maternal outcomes.
What does this mean for nursing? When presenting to the emergency room with pain and jaundice there will also be the fear of how this will affect the baby. With a better understanding of potential procedures the nursing staff can aid in providing support to the patient and encourage the physicians to discuss the impact of treatment on both the mother and child.
References:
Sharma, SS, Maharshi, S. Two stage endoscopic approach for management of choledocholithiasis during pregnancy. J Gastrointestin Liver Dis, 2008: 17(2): 183-5.
Date, RS, Kaushal, M, Ramesh, A; A review of the management of gallstone disease and its complications in pregnancy. Am J Surg 2008 196(4): 599-608.
Submitted by:
Patti Radovich, MSN, CNS, FCCM
CNS Consultant to Ed4Nurses, Inc.
http://www.ed4nurses.com/