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Obstetrics » Obstetrics 2nd And 3rd Trimester
39 week gestation with fetal gallstones
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Presentation A patient came in for a biophysical profile.  She had a failed non-stress test.  She is 29 years old and is morbidly obese.  This is her first pregnancy.  Other than her obesity she has no other risk factors.
 
 
 
Caption: Image of fetal abdomen in a transaxial scanning plane
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Caption: Image of fetal abdomen with area to be magnified indicated
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Caption: Magnified area of the fetal abdomen
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Differential Diagnosis Liver calcifications.
 
Final Diagnosis There are two 2-3mm fetal gallstones.
 
Discussion

Fetal gallstones are a rare occurrence.  They tend to occur in the third trimester. Their cause is unknown but may be related in some cases to maternal anemia or placental abruptions (1,2).  This author has seen four cases of fetal gallstones and three of the patients underwent amniocentesis. 

 

This present case was a late registration and it is unknown whether there was a placental hemorrhage earlier in the pregnancy.  The patient denies any vaginal bleeding during the course of the pregnancy and she was not anemic nor did she undergo amniocentesis.

 

Some fetal gallstones may disappear during the course of the pregnancy and others disappear shortly after delivery.  They may simply pass through the bile duct and into the duodenum or they may dissolve perhaps due to a difference in the chemical properties of fetal bile as compared to adult bile.

 

Fetal gallstones are a benign finding and pose no risk to the fetus or neonate.  It important to distinguish fetal gallstones from liver calcifications, since liver calcifications may herald the presence of an infection or tumor.

 
Case References

1. Brown DL, Teele RL, Doubilet PM, et al. Echogenic material in the fetal gallbladder: sonographic and clinical observations. Radiology 1992; 182:73-76.

2. Klingensmith WC, Cioffi-Ragan DT. Fetal gallstones. Radiology 1988; 167:143-144.

 
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