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Jemds.Com Original Research Article Jemds.com Original Research Article PREVALENCE OF GALLSTONES AMONG PREGNANT WOMEN IN A SOUTH INDIAN DISTRICT Sathiyamoorthy Jothy1 1Faculty, Department of Radiology, Government Theni Medical College and Hospital, Theni, Tamilnadu, India. ABSTRACT BACKGROUND Gallstone disease is more common in women than men. Pregnancy is a known risk factor for developing gallstones.1 We wanted to assess the prevalence of biliary sludge and gallstone disease during pregnancy. METHODS The study was done on 600 pregnant women from community with gestational age upto 25 weeks. It is a retrospective study. Ultrasound images and reports were reviewed. RESULTS The prevalence of biliary sludge and gallstones during pregnancy was found to be 1.3% and 2.7% respectively. CONCLUSIONS The prevalence of either biliary sludge or gallstone among pregnant women with gestational age of upto 25 weeks was 4%. The prevalence of gallstone disease increased with increased parity. HOW TO CITE THIS ARTICLE: Jothy S. Prevalence of gallstones among pregnant women in a South Indian district. J. Evolution Med. Dent. Sci. 2019;8(18):1459-1462, DOI: 10.14260/jemds/2019/325 BACKGROUND Definition of Terms Gallstone disease is more common in women than men. Biliary sludge is defined as echogenic mobile debris layering Pregnancy is a known risk factor for developing gallstones.1 dependently in the gallbladder without posterior acoustic Both the frequency and number of pregnancies are major risk shadowing. Microlithiasis is defined as small calculi that are factors for cholesterol gallstones.2-7 New biliary sludge (A less than 3 mm in size. In this study we included precursor to gallstones) and gallstones may form in pregnant microlithiasis in the biliary sludge category. Gallstones are women.8-11 Gallstones are easily detected with ultrasound. echogenic material (High amplitude echoes) that measure 3 Pregnant women routinely undergo obstetric ultrasound. mm or more; gallstones usually cast acoustic shadowing. This study was carried out to find prevalence of gallstone in Small stones (Less than 5 mm) may not cast acoustic pregnant women by additional upper abdominal ultrasound shadowing1 but will still appear echogenic; mobility screening during routine antenatal ultrasound. differentiates gallstones from polyps.1 Examples of biliary sludge, microlithiasis and gallstones are demonstrated in the METHODS following figures (Figure 1a, Figure 1b and Figure 2) from our Ultrasonography of abdomen and pelvis was performed with study sample. Hitachi Aloka Arietta S60 (Tokyo, Japan) machine with 1-5 MHz convex probe, 3-7 MHz linear probe and 2-10 MHz Statistical Analysis Transvaginal probe. 1-5 MHz convex probe was used for screening of gall bladder. Single radiologist with over 12 Among 600 pregnant women, 24 were found to have years of experience in ultrasound performed all the either gallstone or biliary sludge. ultrasound examinations. Sample size (Number of pregnant women) = 600 Number of positive (Pregnant women with either Study Sample gallstone or sludge) = 24 600 consecutive pregnant women with gestational age upto Confidence interval: 95% 25 weeks (Gestational age as per biometry) who were Confidence interval method: Clopper-Pearson exact referred for routine obstetric ultrasound between November (Binomial proportion confidence interval) 2018 to March 2019 at Vishnupriyadharshini scans, Theni. It Proportion/ prevalence = 0.0400 (4.0%) is a retrospective study. Ultrasonography referral forms, Lower 95% confidence limit is 0.0258 (2.6%) ultrasound images and ultrasound reports were assessed Upper 95% confidence limit is 0.0589 (5.9%) retrospectively. If a pregnant woman had come for more than Proportion of pregnant women with either gallstone or one ultrasound within the study period, she was counted as biliary sludge is 4.0%, 95% confidence interval = 2.6% to single patient. 5.9% ‘Financial or Other Competing Interest’: None. Submission 28-03-2019, Peer Review 23-04-2019, Proportion of primigravida with either gallstone or Acceptance 25-04-2019, Published 06-05-2019. biliary sludge is 3.4%, 95% confidence interval = 1.7% to Corresponding Author: 6.0% Dr. Sathiyamoorthy Jothy, Proportion of multigravida with either gallstone or 163/161, Subban Street, Theni-625531, Tamilnadu, India. biliary sludge is 4.7%, 95% confidence interval = 2.5% to E-mail: [email protected] 7.9% DOI: 10.14260/jemds/2019/325 J. Evolution Med. Dent. Sci./eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 8/ Issue 18/ May 06, 2019 Page 1459 Jemds.com Original Research Article RESULTS There were 600 pregnant women with gestational age upto 25 weeks. Among the 131 women in first trimester, there were 7 cases of ectopic gestations and one with molar pregnancy. Among the 469 women with gestational age of 13 weeks and above, there were 3 women with intrauterine fetal death. Number of Number of Number of all Pregnant Number of Pregnant Pregnant Maternal Women Pregnant Women Women Age in (without or Women with with either Years with with Biliary Gallstone Gallstone or Gallstone Sludge or Sludge Sludge) Figure 1a. Showing Biliary Sludge as Layering 18-20 106 0 0 0 Echogenic Material in Gallbladder without Shadowing 21-25 268 9 6 15 26-30 159 6 1 7 31-35 56 1 1 2 36-40 10 0 0 0 41-45 1 0 0 0 Total 600 16 8 24 Table 1. Age Distribution Number of Number Number of Number of all Pregnant of Pregnant Pregnant Women Pregnant Women Women Gravida (with or Women with with either without with Biliary Gallstone Gallstone) Gallstone Sludge or Sludge Primigravida 324 6 5 11 Multigravida 276 10 3 13 Figure 1b. Showing Biliary Sludge/Microlithiasis (Same Total 600 16 8 24 Patient as in Figure 1a, but After 10 Weeks). We can Table 2 Appreciate Faint Shadowing in Figure 1b. Sludge has Become Microlithiasis in 10 Weeks’ Time Number of Number of Number all Number of Pregnant of Pregnant Pregnant Women Gestational Pregnant Women Women with Age Women (with or with either with without Gallstone Gallstone Sludge Gallstone) or Sludge ≤ 12 weeks 131 3 2 5 13-25 weeks 469 13 6 19 Table 3 Number of Number of Number of all Number of Pregnant Pregnant Pregnant Pregnant Women Type of Women Women Women with Pregnancy with (with or with either Biliary without Gallstone Gallstone Sludge Gallstone) or Sludge Figure 2. Showing Cholelithiasis. Two Calculi in The Lumen Singleton 578 15 8 23 of Gallbladder with Posterior Acoustic Shadowing Twin 11 1 0 1 pregnancy Note Table 4 Calcific foci in liver (Suggesting healed infections) and haemangiomas in liver are not uncommon; these cases are Chronic calcific not included in the incidentally detected findings. Renal 2 pancreatitis calculi are prevalent in our region and so we do not include Portal cavernoma 1 renal calculi in the incidentally detected findings. Table 5. Incidentally Detected other Hepatobiliary/ Pancreatic Diseases in These Pregnant Women during Upper Abdominal Ultrasound Screening J. Evolution Med. Dent. Sci./eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 8/ Issue 18/ May 06, 2019 Page 1460 Jemds.com Original Research Article Inclusion Criteria pregnant women (With gestation age upto 25 weeks) was Pregnant women (Belonging to any age group and any parity) 2.7%. with gestational age upto 25 weeks (Gestational age as per We found two cases of chronic calcific pancreatitis among biometry). Screening ultrasound of upper abdomen was not these 600 pregnant women. Neither of these two had performed in pregnant women with gestational age of 26 gallstones or sludge. Both of them had diabetes, and prior to weeks and above and so they were not included in the study. ultrasound they were considered to have gestational Twin pregnancies were also included in the study sample. diabetes. After ultrasound, the diagnosis was changed to type Ectopic gestations and intrauterine fetal deaths were also 1 diabetes and both of them are on insulin at time of writing included in the study sample. of this article. Detection of chronic calcific pancreatitis on upper abdominal screening in pregnant women is beneficial Exclusion Criteria for appropriate management of patients. History of cholecystectomy. During the study period, there was mention of history of cholecystectomy in ultrasound Limitations reports of two pregnant women, who were excluded. Those 1. We did not study the incidence of gallstone during with missed abortion or complete abortions (During study pregnancy. We studied the prevalence only. To study period) were not included in the study. incidence, we have to do prospective study, enrolling patients, and follow them up to find, how many among DISCUSSION During pregnancy oestrogen and progesterone levels the pregnant women (Who have no gallstone or sludge increase. Increased oestrogen increases biliary secretion of in first study at time of enrolment) subsequently develop cholesterol and decreases secretion of bile salts. Increased ‘new’ stone or sludge during course of pregnancy. progesterone causes gallbladder stasis. Together these 2. We had not performed screening of upper abdomen in mechanisms predispose to gallstone formation.9,12 all pregnant women. We confined our study to pregnant In our study we found 24 (4%) cases of gallstones/ biliary women with gestational age upto 25 weeks. This is a sludge (either gallstones or biliary sludge) in 600 pregnant major limitation as sludge formation begins in the first women with gestational age upto 25 weeks. There were 16 trimester and increases up to 4 to 6 weeks post- cases (2.7%) of gallstones and 8 cases (1.3%) of biliary partum15. Study done by Richa Gangwar et al also shows sludge. increased incidence of biliary sludge and gallstones in Among 324 primigravida, 11 (3.4 % of primigravida, 1 in third trimester of pregnancy. So, it is possible that our 29 primigravida) had gallstones/ biliary sludge (either study underestimates the total prevalence of gallstones gallstones or biliary sludge). Among 276 multigravidas, 13 in pregnant women as it does not address prevalence of (5% of multigravida, 1 in 21 multigravida) had gallstones/ gallstone in pregnant women in third trimester.
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