Surgical Management During Pregnancy

Preoperative Considerations

Laparoscopic procedures can be safely performed during pregnancy with appropriate modifications, including operative time limited to 90-120 minutes, low intra-abdominal pressure (10-13 mmHg), open introduction technique, and an experienced surgeon, as recommended by the American College of Surgeons 1, 2
Current guidelines recommend laparoscopic procedures when possible, with careful monitoring of maternal condition to ensure maternal and fetal well-being, according to the American College of Surgeons 1, 2

Pregnant women after 20 weeks should be positioned with left uterine displacement to prevent aortocaval compression, and adequate maternal oxygenation and optimal uteroplacental perfusion should be maintained throughout the procedure, as recommended by the American Society of Anesthesiologists 3
Strategies to avoid hypoxemia, hypotension, acidosis, and hyperventilation are critical elements of anesthetic management, according to the American Society of Anesthesiologists 3

Multimodal analgesia including regional techniques, local anesthetic infiltration, and judicious opioid use is safe in pregnancy, and adequate pain relief is essential to prevent reactive preterm contractions, as recommended by the American College of Obstetricians and Gynecologists 3
Paracetamol is the analgesic of choice for mild to moderate pain during any stage of pregnancy, according to the American College of Obstetricians and Gynecologists 3

Pregnancy-associated gastroesophageal reflux increases the risk of aspiration during surgery, and maternal hypotension can cause reduced placental blood flow and fetal hypoxia, as noted by the American Society of Anesthesiologists 2