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

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 US 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 US. 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.