Gallbladder disease, especially acute cholecystitis, is the second non-obstetric condition after acute appendicitis that causes acute abdomen during pregnancy, with an incidence of approximately 1 in 1600-10000 pregnant women. 3.5% to 10% of pregnant women have gallbladder stones, which are the main cause of acute cholecystitis in 90% of pregnant women. In patients who are not pregnant, cholecystitis usually presents with nausea, vomiting, dyspepsia, intolerance of fatty foods, right upper abdominal cramps or epigastric pain radiating to the back. However, Murphy’s sign is mostly indefinite in women in late pregnancy. The differential diagnosis includes a variety of conditions in which acute obstetric pathologies must be considered, such as acute fatty liver during pregnancy, new onset preeclampsia, and HELLP syndrome (hemolysis, elevated liver enzymes, and thrombocytopenia syndrome) complicated by preeclampsia. Other differential diagnoses should also include acute appendicitis, pre-eclampsia, acute hepatitis, acute pancreatitis, peptic ulcer, acute right-sided pyelonephritis, and right-sided hypopneumonia. When reviewing laboratory results, it is important to know that elevated ALP (alkaline phosphatase) is a normal physiologic manifestation of pregnancy. Ultrasound is non-invasive, non-radioactive, easy to use, and has a sensitivity of 95-98%, making it the primary adjunctive diagnostic tool for cholecystitis in pregnancy. Traditional criteria for the diagnosis of acute cholecystitis by ultrasound include a positive Murphy’s sign, detection of gallbladder stones, gallbladder enlargement (>4 cm), intra-biliary sludge, gallbladder wall thickening (>4 mm), and peri-biliary fluid accumulation. Dilation of the intrahepatic or extrahepatic bile ducts suggests the possible presence of common bile duct stones. Surgical removal of the gallbladder is the first-line treatment for acute cholecystitis in pregnancy, reducing drug use and avoiding recurrence of cholecystitis, which can be 44-92% after drug treatment, depending on the gestation period. Surgery can reduce the length of hospital stay and avoid serious complications such as sepsis or peritonitis due to gallbladder perforation. In addition, symptomatic gallbladder stones carry a 10% risk of acute calculous pancreatitis and a 10-20% risk of miscarriage. Related studies have found that non-surgical treatment increases the risk of spontaneous miscarriage, preterm miscarriage and preterm delivery in pregnant women compared to those with gallbladder removal. Laparoscopic cholecystectomy should be preferred before the start of the third trimester. The mortality rate of laparoscopic cholecystectomy in pregnant women does not increase with pregnancy and is the same as normal.