Objective: To evaluate the clinical efficacy of ultrasound guided percutaneous puncture and drainage of the gallbladder (PPDG) in treatment of acute calculous cholecystitis during middle and late pregnancy. Methods: The clinical data of 47 women with acute calculous cholecystitis during middle or late pregnancy undergoing ultrasound guided PPDG from September 2010 to October 2015 were retrospectively analyzed. Results: PPDG was successfully performed in all the 47 patients. After treatment, the symptoms such as abdominal pain and fever were relieved quickly, no complications such as hemorrhage or biliary fistula occurred, and the laboratory parameters that included white blood cell count, and transaminase, total bilirubin and procalcitonin levels were statistically improved compared with preoperative findings (all P<0.05). Except in one patient whose tube fell out at 7 days after tube placement, all the remaining patients underwent regular tube removal or had tube removal during elective surgery after delivery. Of the 47 patients, 28 cases had spontaneous labor, and 19 had caesarean section, and all the neonates were physically normal at birth. Conclusion: Ultrasound guided PPDG is an effective, safe and convenient method of treatment for acute calculous cholecystitis during middle and late pregnancy, and it is recommended to be used in clinical practice.