Prevalence of kidney stones are rising and also occur during pregnancy with increasing frequency as pregnancy progresses and stone formation during pregnancy is unique due to physiologic changes during pregnancy. Symptomatic kidney stone events during pregnancy are complex in terms of diagnosis and with unique potential maternal and fetal risks. Radiation exposure concerns create a challenge with regards to diagnosis and treatment. Conservative management is preferred when appropriate; however, intervention with temporary drainage or ureteroscopy is safe to perform when necessary. Careful patient selection and multidisciplinary approach are critical for successful outcomes to maximize safety for the mother and fetus.