Symptomatic gallstones are common in pregnant women, but acute cholecystitis is uncommon. Cholelithiasis is the presence of gallstones in the gallbladder. A diagnosis of cholelithiasis may be incidental or may be suspected on the basis of classic symptoms with confirmation on ultrasound. Up to 50% of pregnant women with cholelithiasis are asymptomatic. There are three major types of gallstones: Cholesterol, pigmented, and mixed. Mode of delivery is not impacted by the presence of gallstones. Cesarean section should be performed for obstetric indications. Acute cholecystitis is inflammation of the gallbladder. A diagnosis of acute cholecystitis should be made on the basis of characteristic history and physical examination. Maternal risks include sepsis, cholangitis, pancreatitis, empyema of the gallbladder, gangrene and perforation, fistula formation, gallstone ileus, porcelain gallbladder with associated increased risk of gallbladder cancer. Fetal death occurred in 7% of women treated conservatively versus 2% of women treated with laparoscopic cholecystectomy.