Risk factors and features of treatment biliary sludge during pregnancy

Pregnancy is a proven risk for the development of gallstone disease (GSD) and biliary sludge (BS). The prevalence of GSD among pregnant women, especially at the stage of BS, is high, but in a significant number of cases their spontaneous resolution after delivery appears. Cases of GSD not regressing after childbirth associated with a high degree of complications and surgical interventions. Though the principles of treatment and prevention of GSD and BS during pregnancy are not defined. The aim of the study - to identify the risk factors for the GSD at the BS stage during pregnancy and to work out approaches to its treatment and prevention. Materials and methods. 61 pregnant women with ultrasound signs of BS detected during this pregnancy were included. The control group consisted of 50 healthy pregnant women. Patients were underwent general clinical, ultrasound, laboratory methods of investigation. The basic therapy included an ursodeoxycholic acid in a dose of 250-750 mg for 2 months in the evening single dose. Ultrasound control of the BS`s treatment effectiveness was performed after 2 months of therapy. Results. The risk factors for the formation of BS during pregnancy were heredity for GSD (p=0.008), the sex hormones drugs using during pregnancy (p<0.001), the older age of the patient (p<0.001), the presence of functional disorders of the biliary tract (p=0.003), polycystic ovary syndrome - PCOS (p=0.031), dyslipidemia (p=0.001), use of artificial reproductive technologies programs - ART (p<0.001) and multiple pregnancies (p=0.03). The prognostic factors of insufficient effectiveness of BS treatment with ursodeoxycholic acid drugs during the gestation period were the older age of the patients (p=0.001), the presence of PCOS (p=0.075), the use of progesterone drugs during pregnancy (p<0.001), the ART using (p=0.027), the presence of hyperemesis gravidarum (p<0.001). Conclusion. Early detection of BS in risk groups, adequate dynamic control over its course and a differentiated approach to the management of patients with BS allows to increase the effectiveness of treatment and prevent the development of GSD during pregnancy. Patients with prognostic factors of insufficient effectiveness of BS treatment during gestation require longer therapy with follow-up to prevent its recurrence.

gallstone disease, biliary sludge, pregnancy, risk factors, female sex hormones