Urgent laparoscopic surgeries during the third trimester of pregnancy: A case series

ABSTRACT Study objective Laparoscopic management of non-obstetric acute abdominal pain in the third trimester of pregnancy remains controversial with limited data regarding procedure safety and feasibility. This study aimed to investigate the feasibility, immediate complications, and short-term outcomes of laparoscopic surgery at an advanced gestational age. Design Clinical data were retrospectively collected and analyzed. A telephone questionnaire was administered in case of missing data. Clinical information obtained included detailed medical and obstetric history; preoperative, intraoperative, and postoperative data; complications, and pregnancy outcomes. Setting Sheba Medical Center, a tertiary referral center. Patients Pregnant women who underwent urgent laparoscopic surgery at 27 weeks of gestation and above. Intervention Emergent laparoscopic surgery. Measurements and Main Results Between January 2010 and July 2017, 12 patients underwent emergent laparoscopic surgeries during the third trimester of pregnancy. The gestational age at the time of the surgery ranged between 27 and 38 weeks. All women had singleton pregnancies. Laparoscopic surgeries included seven appendectomies, four adnexal surgeries, and one diagnostic laparoscopy. No complications related to the access route for any of the 12 laparoscopic surgeries occurred. The laparoscopic surgical procedure was successfully completed in 11 patients; only one laparoscopic appendectomy for perforated acute appendicitis with purulent peritonitis at 30 weeks of gestation was converted to laparotomy because of a limited operative field. Two patients had preterm labor at 35 and 36 weeks of gestation, respectively. None of the women was complicated with intrauterine fetal demise or low APGAR scores. Conclusions Our results demonstrate that urgent laparoscopic surgeries in the third trimester of pregnancy are feasible, and they can be safely performed with minimal risk for the patient and fetus. Larger prospective studies are required to validate these recommendations.