The natural history of fetal gallstones: a case series and updated literature review

Abstract

Introduction

The incidence of fetal gallstones is estimated at 0.45% and its clinical relevance after birth remains unknown. This study aimed to describe the natural history of fetal gallstones and their clinical sequelae after birth.

Methods

We queried a database of fetuses referred for second and third trimester sonograms performed for high-risk pregnancies, and identified cases with fetal gallstones (1996–2019). Demographics, prenatal/postnatal imaging findings, and clinical sequelae were collected. A literature review was performed according to PRISMA guidelines.

Results

We screened approximately 200,000 obstetric sonograms; 34 fetuses were found to have cholelithiasis. The median gestational age at the time of sonogram was 35 weeks (range 22–38). Fifty-six percent were female and 11.8% were twin pregnancies with one affected fetus. Median maternal age was 28 years (range 17–42). Eight fetuses underwent postnatal imaging and 4 had persistent cholelithiasis. There was one case of in utero demise. Two patients had structural anomalies (renal and cardiac) by sonogram. A subset of 17 patients was followed long-term (range 3–20 years), and none developed clinical sequelae from cholelithiasis.

Discussion/Conclusions

No child developed postnatal clinical sequelae related to cholelithiasis identified in utero. Fetal cholelithiasis can be managed expectantly without follow-up imaging in asymptomatic patients.

Keywords:

• Fetal gallstones
• prenatal ultrasound
• cholelithiasis

Acknowledgments

We thank Dr. Shilpa Chetty for her generous assistance with data acquisition.

Disclosure statement

The authors report no conflict of interest. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Data availability statement

The data that support the findings of this study are openly available in Dryad at https://doi.org/10.7272/Q6H70D1J.

Additional information

Funding

This project was supported by the National Institutes of Health [T32AI125222] (Schwab, Braun).