Abstract
Gallstone disease during pregnancy, or cholelithiasis, presents significant clinical challenges due to hormonal, anatomical, and metabolic changes. Progesterone therapy, commonly used in pregnancy for uterine bleeding, can exacerbate gallstone risk by reducing gallbladder motility and promoting cholesterol gallstone formation. This case report describes a 29-year-old pregnant woman with no prior gallbladder disease who developed multiple cholesterol gallstones during the third trimester while undergoing progesterone therapy for bleeding associated with a bicornuate uterus. Conservative management during pregnancy, including dietary modifications and close monitoring, was successful, and the patient delivered a healthy infant via cesarean section. Postpartum, the patient developed obstructive jaundice, severe right hypochondriac pain, and scleral icterus due to common bile duct obstruction from gallstones. Endoscopic retrograde cholangiopancreatography (ERCP) with biliary stent placement resolved the obstruction, and pharmacological treatment with ursodeoxycholic acid (UDCA) and omega-3 fatty acids led to complete gallstone resolution within three months. Surgical intervention was avoided to prioritize postpartum recovery and breastfeeding, which resumed successfully after a brief interruption. This case highlights the value of individualized, multidisciplinary care in managing pregnancy-associated gallstone disease. Conservative approaches, including pharmacological and minimally invasive interventions, can achieve effective outcomes while minimizing maternal-fetal risks. Routine ultrasound screening in high-risk pregnancies and further investigation into UDCA and omega-3 therapies, progesterone-related gallbladder stasis, and postpartum biliary stenting protocols are recommended to optimize management strategies.