Acute calculus cholecystitis during pregnancy represents the second most prevalent cause of non-obstetric abdominal pain in this population. Clinically, it manifests as upper abdominal pain, with ultrasonography serving as the primary imaging technique for diagnosis. Management strategies for acute calculus cholecystitis in pregnant patients can be categorized into non-operative approaches, which include the administration of intravenous antibiotics and analgesics, and laparoscopic cholecystectomy, which is feasible across all three trimesters of pregnancy. Both therapeutic modalities are associated with potential maternal complications and fetal loss. This review aims to examine the diagnostic and therapeutic approaches for acute calculus cholecystitis in pregnancy. We will explore the roles of both conservative treatment and cholecystectomy in managing this condition, as well as the potential application of gallbladder drainage in pregnant patients with acute calculus cholecystitis.