Laparoscopy during Pregnancy

The two most common surgical procedures performed during the gestational period are for appendicitis and gallbladder disease (acute cholecystitis and symptomatic cholelithiasis), both of which are completely safe to perform during the second trimester.

• First trimester—generally contraindicated unless emergency because of 12% miscarriage rate and risk of teratogenesis

• Second trimester—regarded as the safest time. The risk of miscarriage and teratogenesis is close to 0% and the rate of preterm labor is 5-8%

• Third trimester—difficult due to inadequate visualization and 30% risk of preterm labor.

Precautions for laparoscopy in pregnant patients include, lower intraabdominal pressures, minimizing the degree of reverse Trendelenburg and manipulation of uterus, and placement of the patient in the left lateral position to avoid compression of the vena cava.

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