BILIARY TRACT DISEASES IN PREGNANCY: DIFFERENTIAL DIAGNOSIS AND OBSTETRIC MANAGEMENT

Introduction: Biliary tract diseases are among the most frequent non-obstetric conditions that complicate pregnancy, with a clinical spectrum ranging from asymptomatic cholelithiasis to severe cholangitis. Hormonal and anatomical changes during gestation increase susceptibility to biliary pathology, often complicating diagnosis and treatment. The overlap of symptoms with other obstetric or gastrointestinal disorders presents a challenge for accurate clinical assessment. Objective: To review the differential diagnoses and clinical management strategies of biliary tract diseases in pregnancy, with emphasis on diagnostic modalities, risk stratification, and safe therapeutic approaches tailored to maternal and fetal outcomes. Methods: This narrative review was conducted using a structured search of recent literature in PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar. The selection focused on studies published in the last five years that addressed diagnosis, medical and surgical management, and outcomes of biliary diseases during pregnancy. Results and Discussion: Intrahepatic cholestasis of pregnancy is the most specific hepatobiliary disorder of gestation, requiring careful bile acid monitoring and timely delivery. Gallstones and cholecystitis also have increased prevalence in pregnancy and may require laparoscopic intervention. Choledocholithiasis, cholangitis, and rare autoimmune cholangiopathies require individualized diagnosis and therapeutic planning. Imaging choices, pharmacologic limitations, and surgical indications must be balanced against gestational risks. Conclusion: Biliary diseases during pregnancy pose diagnosis and management complexities that demand interdisciplinary approaches. Timely recognition and evidence-based management optimize maternal safety and fetal health. More robust prospective studies are needed to refine diagnostic thresholds and treatment protocols for this population.