A 32-Year-Old Primigravid Woman at 36 Weeks Gestation Comes to the Office

A 32-year-old primigravid woman at 36 weeks gestation comes to the office for consultation regarding abnormal test results.  The tests were part of an evaluation for an episode of burning epigastric pain that radiated to the chest and has since resolved without treatment.  The patient has fatigue and malaise but attributes these symptoms to pregnancy.  She has no chronic medical conditions and has had no surgeries.  The patient takes a prenatal vitamin daily and acetaminophen as needed for lower back pain.  She does not use tobacco, alcohol, or illicit drugs.  The patient's father died of alcoholic cirrhosis, and her mother underwent a cholecystectomy for gallstone cholecystitis.
Blood pressure is 120/70 mm Hg and pulse is 82/min.  Examination reveals a nontender gravid uterus appropriate for gestational age and 1+ bilateral pedal edema.  The remainder of the physical examination is unremarkable.
Laboratory results are as follows:
Abdominal ultrasound shows normal liver echogenicity, a liver span of 12 cm, a normal-sized spleen, a gallbladder with multiple stones, and a common bile duct size of 4 mm.  There is no pericholecystic fluid.
Which of the following is the best next step in management of this patient?

A) No further intervention indicated
B) Order hepatobiliary cholescintigraphy (HIDA scan)
C) Prescribe ursodeoxycholic acid
D) Recommend early delivery
E) Refer for cholecystectomy

Correct Answer:

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