Surgical Endoscopy

, Volume 22, Issue 9, pp 1917–1927 | Cite as

Diagnosis and laparoscopic treatment of surgical diseases during pregnancy: an evidence-based review

  • Heidi Jackson
  • Steven Granger
  • Raymond PriceEmail author
  • Michael Rollins
  • David Earle
  • William Richardson
  • Robert Fanelli


Treatment of surgical disease in the gravid patient requires a unique and careful approach where safety of the mother and fetus are both considered. Approaches to diagnosis and therapy of surgical disease in the gravid patient are increasingly clarified and defined in the literature. Laparoscopy, once described as contraindicated in pregnancy, has been steadily accepted and applied as data supporting its safety and use have accumulated. An extensive review of the literature was performed to define the use of laparoscopy in pregnancy. Diagnoses for independent surgical diseases as well as imaging modalities and techniques during pregnancy are reviewed. Preoperative, intraoperative, and postoperative management of the pregnant patient are described and evaluated with focus on use of laparoscopy. Literature supporting safety and efficacy of laparoscopy in cholecystectomy, appendectomy, solid organ resection, and oophorectomy in the gravid patient is outlined. Based on level of evidence, this review includes recommendations specific to surgical approach, trimester of pregnancy, patient positioning, port placement, insufflation pressure, monitoring, venous thromboembolic prophylaxis, obstetric consultation, and use of tocolytics in the pregnant patient.


Laparoscopy Pregnancy Cholecystectomy Appendectomy Guidelines Radiology 


  1. 1.
    Kammerer WS (1979) Nonobstetric surgery during pregnancy. Med Clin North Am 63(6):1157–1164Google Scholar
  2. 2.
    Kort B, Katz VL, Watson WJ (1993) The effect of nonobstetric operation during pregnancy. Surg Gynecol Obstet 177(4):371–376PubMedGoogle Scholar
  3. 3.
    Fallon WF Jr et al (1995) The surgical management of intra-abdominal inflammatory conditions during pregnancy. Surg Clin North Am 75(1):15–31PubMedGoogle Scholar
  4. 4.
    Eyvazzadeh AD, Levine D (2006) Imaging of pelvic pain in the first trimester of pregnancy. Radiol Clin North Am 44(6):863–877PubMedCrossRefGoogle Scholar
  5. 5.
    Medical radiation exposure of pregnant and potentially pregnant women (1977) National Council on Radiation Protection and Measurements report no. 54, Bethesda, MDGoogle Scholar
  6. 6.
    Kennedy A (2000) Assessment of acute abdominal pain in the pregnant patient. Semin Ultrasound CT MR 21(1):64–77PubMedCrossRefGoogle Scholar
  7. 7.
    Toppenberg KS, Hill DA, Miller DP (1999) Safety of radiographic imaging during pregnancy. Am Fam Physician 59(7):1813–1818, 1820PubMedGoogle Scholar
  8. 8.
    Moore C, Promes SB (2004) Ultrasound in pregnancy. Emerg Med Clin North Am 22(3):697–722PubMedCrossRefGoogle Scholar
  9. 9.
    Lim HK, Bae SH, Seo GS (1992) Diagnosis of acute appendicitis in pregnant women: value of sonography. AJR Am J Roentgenol 159(3):539–542PubMedGoogle Scholar
  10. 10.
    Nelson MJ et al (1986) Cysts in pregnancy discovered by sonography. J Clin Ultrasound 14(7):509–512PubMedCrossRefGoogle Scholar
  11. 11.
    Timins JK (2001) Radiation during pregnancy. N J Med 98(6):29–33PubMedGoogle Scholar
  12. 12.
    Karam PA (2000) Determining and reporting fetal radiation exposure from diagnostic radiation. Health Phys 79(5 Suppl):S85–S90PubMedCrossRefGoogle Scholar
  13. 13.
    Doll R, Wakeford R (1997) Risk of childhood cancer from fetal irradiation. Br J Radiol 70:130–139PubMedGoogle Scholar
  14. 14.
    Osei EK, Faulkner K (1999) Fetal doses from radiological examinations. Br J Radiol 72(860):773–780PubMedGoogle Scholar
  15. 15.
    Lowe SA (2004) Diagnostic radiography in pregnancy: risks and reality. Aust N Z J Obstet Gynaecol 44(3):191–196PubMedCrossRefGoogle Scholar
  16. 16.
    Menias CO et al (2007) CT of pregnancy-related complications. Emerg Radiol 13(6):299–306PubMedCrossRefGoogle Scholar
  17. 17.
    Hurwitz LM et al (2005) Radiation dose to the fetus from body MDCT during early gestation. AJR Am J Roentgenol 186(3):871–876CrossRefGoogle Scholar
  18. 18.
    Forsted DH, Kalbhen CL (2002) CT of pregnant women for urinary tract calculi, pulmonary thromboembolism, and acute appendicitis. AJR Am J Roentgenol 178(5):1285PubMedGoogle Scholar
  19. 19.
    De Wilde JP, Rivers AW, Price DL (2005) A review of the current use of magnetic resonance imaging in pregnancy and safety implications for the fetus. Prog Biophys Mol Biol 87(2–3):335–353PubMedGoogle Scholar
  20. 20.
    Garcia-Bournissen F, Shrim A, Koren G (2006) Safety of gadolinium during pregnancy. Can Fam Physician 52:309–310PubMedGoogle Scholar
  21. 21.
    Nagayama M et al (2002) Fast MR imaging in obstetrics. Radiographics 22(3):563–580; discussion 580–582PubMedGoogle Scholar
  22. 22.
    Leyendecker JR, Gorengaut V, Brown JJ (2004) MR imaging of maternal diseases of the abdomen and pelvis during pregnancy and the immediate postpartum period. Radiographics 24(5):1301–1316PubMedCrossRefGoogle Scholar
  23. 23.
    McKenna DA et al (2007) The use of MRI to demonstrate small bowel obstruction during pregnancy. Br J Radiol 80(949):e11–e14PubMedCrossRefGoogle Scholar
  24. 24.
    Adelstein S(1999) Administered radionuclides in pregnancy. Teratology 59(4):236–239PubMedCrossRefGoogle Scholar
  25. 25.
    Andriulli A et al (2007) Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol 102(8):1781–1788PubMedCrossRefGoogle Scholar
  26. 26.
    Qureshi WA et al (2005) ASGE guideline: guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc 61(3):357–362PubMedCrossRefGoogle Scholar
  27. 27.
    Quan WL, Chia CK, Yim HB (2006) Safety of endoscopical procedures during pregnancy. Singapore Med J 47(6):525–528PubMedGoogle Scholar
  28. 28.
    Reedy MB, Kallen B, Kuehl TJ (1997) Laparoscopy during pregnancy: a study of five fetal outcome parameters with use of the Swedish Health Registry. Am J Obstet Gynecol 177(3):673–679PubMedCrossRefGoogle Scholar
  29. 29.
    Reedy MB et al (1997) Laparoscopy during pregnancy. A survey of laparoendoscopic surgeons. J Reprod Med 42(1):33–38PubMedGoogle Scholar
  30. 30.
    Gurbuz AT, Peetz ME (1997) The acute abdomen in the pregnant patient. Is there a role for laparoscopy? Surg Endosc 11(2):98–102PubMedCrossRefGoogle Scholar
  31. 31.
    Buser KB (2002) Laparoscopic surgery in the pregnant patient–one surgeon’s experience in a small rural hospital. JSLS 6(2):121–124PubMedGoogle Scholar
  32. 32.
    Lachman E et al (1999) Pregnancy and laparoscopic surgery. J Am Assoc Gynecol Laparosc 6(3):347–351PubMedCrossRefGoogle Scholar
  33. 33.
    Fatum M, Rojansky N (2001) Laparoscopic surgery during pregnancy. Obstet Gynecol Surv 56(1):50–59PubMedCrossRefGoogle Scholar
  34. 34.
    Curet MJ et al (1996) Laparoscopy during pregnancy. Arch Surg 131(5):546–550; discussion 550–551PubMedGoogle Scholar
  35. 35.
    Conron RW Jr et al (1999) Laparoscopic procedures in pregnancy. Am Surg 65(3):259–263PubMedGoogle Scholar
  36. 36.
    Al-Fozan H, Tulandi T (2002) Safety and risks of laparoscopy in pregnancy. Curr Opin Obstet Gynecol 14(4):375–379PubMedCrossRefGoogle Scholar
  37. 37.
    Amos JD et al (1996) Laparoscopic surgery during pregnancy. Am J Surg 171(4):435–437PubMedCrossRefGoogle Scholar
  38. 38.
    Nezhat FR et al (1997) Laparoscopy during pregnancy: a literature review. JSLS 1(1):17–27PubMedGoogle Scholar
  39. 39.
    Guidelines for laparoscopic surgery during pregnancy (1998) Surg Endosc 12(2):189–190CrossRefGoogle Scholar
  40. 40.
    Rizzo AG (2003) Laparoscopic surgery in pregnancy: long-term follow-up. J Laparoendosc Adv Surg Tech A 13(1):11–15PubMedCrossRefGoogle Scholar
  41. 41.
    Andreoli M et al(1999) Laparoscopic surgery during pregnancy. J Am Assoc Gynecol Laparosc 6(2):229–233PubMedCrossRefGoogle Scholar
  42. 42.
    Shay DC, Bhavani-Shankar K, Datta S (2001) Laparoscopic surgery during pregnancy. Anesthesiol Clin North Am 19(1):57–67CrossRefGoogle Scholar
  43. 43.
    Oelsner G et al (2003) Pregnancy outcome after laparoscopy or laparotomy in pregnancy. J Am Assoc Gynecol Laparosc 10(2):200–204PubMedCrossRefGoogle Scholar
  44. 44.
    McKellar DP et al (1992) Cholecystectomy during pregnancy without fetal loss. Surg Gynecol Obstet 174(6):465–468PubMedGoogle Scholar
  45. 45.
    Glasgow RE et al (1998) Changing management of gallstone disease during pregnancy. Surg Endosc 12(3):241–246PubMedCrossRefGoogle Scholar
  46. 46.
    Affleck DG et al (1999) The laparoscopic management of appendicitis and cholelithiasis during pregnancy. Am J Surg 178(6):523–529PubMedCrossRefGoogle Scholar
  47. 47.
    Barone JE et al (1999) Outcome study of cholecystectomy during pregnancy. Am J Surg 177(3):232–236PubMedCrossRefGoogle Scholar
  48. 48.
    Rollins MD, Chan KJ, Price RR (2003) Laparoscopy for appendicitis and cholelithiasis during pregnancy: a new standard of care. Surg EndoscGoogle Scholar
  49. 49.
    Geisler JP et al (1998) Non-gynecologic laparoscopy in second and third trimester pregnancy: obstetric implications. JSLS 2(3):235–238PubMedGoogle Scholar
  50. 50.
    Stepp K, Falcone T (2004) Laparoscopy in the second trimester of pregnancy. Obstet Gynecol Clin North Am 31(3):485–496, viiPubMedCrossRefGoogle Scholar
  51. 51.
    Davis A, Katz VL, Cox R (1995) Gallbladder disease in pregnancy. J Reprod Med 40(11):759–762PubMedGoogle Scholar
  52. 52.
    Muench J et al (2001) Delay in treatment of biliary disease during pregnancy increases morbidity and can be avoided with safe laparoscopic cholecystectomy. Am Surg 67(6):539–542; discussion 542–543PubMedGoogle Scholar
  53. 53.
    Visser BC et al (2001) Safety and timing of nonobstetric abdominal surgery in pregnancy. Dig Surg 18(5):409–417PubMedCrossRefGoogle Scholar
  54. 54.
    Pucci RO, Seed RW (1991) Case report of laparoscopic cholecystectomy in the third trimester of pregnancy. Am J Obstet Gynecol 165(2):401–402PubMedGoogle Scholar
  55. 55.
    Weber AM et al (1991) Laparoscopic cholecystectomy during pregnancy. Obstet Gynecol 78(5 Pt 2):958–959PubMedGoogle Scholar
  56. 56.
    Williams JK et al (1995) Laparoscopic cholecystectomy in pregnancy. A case report. J Reprod Med 40(3):243–245Google Scholar
  57. 57.
    Arvidsson D, Gerdin E (1991) Laparoscopic cholecystectomy during pregnancy. Surg Laparosc Endosc 1(3):193–194PubMedGoogle Scholar
  58. 58.
    Costantino GN et al (1994) Laparoscopic cholecystectomy in pregnancy. J Laparoendosc Surg 4(2):161–164PubMedGoogle Scholar
  59. 59.
    Soriano D et al (1999) Laparoscopy versus laparotomy in the management of adnexal masses during pregnancy. Fertil Steril 71(5):955–960PubMedCrossRefGoogle Scholar
  60. 60.
    Curet MJ (2000) Special problems in laparoscopic surgery. Previous abdominal surgery, obesity, and pregnancy. Surg Clin North Am 80(4):1093–1110PubMedCrossRefGoogle Scholar
  61. 61.
    Elkayam U GN (1982) Cardiovascular physiology of pregnancy. In: Elkayam U GN (ed) Cardiac problems in pregnancy: diagnosis and management of maternal and fetal disease. Alan R Liss, New York, p 5Google Scholar
  62. 62.
    Clark SL et al (1991) Position change and central hemodynamic profile during normal third-trimester pregnancy and post partum. Am J Obstet Gynecol 164(3):883–887PubMedGoogle Scholar
  63. 63.
    Gordon MC (2002) Maternal physiology in pregnancy. In: Gabbe SG, Niebyl JR, Simpson JL (eds) Obstetrics: normal and problem pregnancies. Churchill Livingstone, Philadelphia, pp 63–91Google Scholar
  64. 64.
    Friedman JD et al (2002) Pneumoamnion and pregnancy loss after second-trimester laparoscopic surgery. Obstet Gynecol 99(3):512–513PubMedCrossRefGoogle Scholar
  65. 65.
    Halpern NB (1998) Laparoscopic cholecystectomy in pregnancy: a review of published experiences and clinical considerations. Semin Laparosc Surg 5(2):129–134PubMedGoogle Scholar
  66. 66.
    Lemaire BM, van Erp WF (1997) Laparoscopic surgery during pregnancy. Surg Endosc 11(1):15–18PubMedCrossRefGoogle Scholar
  67. 67.
    Canis M et al (2002) Laparoscopic management of adnexal masses: a gold standard? Curr Opin Obstet Gynecol 14(4):423–428PubMedCrossRefGoogle Scholar
  68. 68.
    Malangoni MA (2003) Gastrointestinal surgery and pregnancy. Gastroenterol Clin North Am 32(1):181–200PubMedCrossRefGoogle Scholar
  69. 69.
    Wang CJ et al (2002) Minilaparoscopic cystectomy and appendectomy in late second trimester. JSLS 6(4):373–375PubMedGoogle Scholar
  70. 70.
    Akira S et al (1999) Gasless laparoscopic ovarian cystectomy during pregnancy: comparison with laparotomy. Am J Obstet Gynecol 180(3 Pt 1):554–557PubMedCrossRefGoogle Scholar
  71. 71.
    Murakami T et al (2003) Cul-de-sac packing with a metreurynter in gasless laparoscopic cystectomy during pregnancy. J Am Assoc Gynecol Laparosc 10(3):421–423PubMedCrossRefGoogle Scholar
  72. 72.
    Schmidt T et al (2001) Gasless laparoscopy as an option for conservative therapy of adnexal pedical torsion with twin pregnancy. J Am Assoc Gynecol Laparosc 8(4):621–622PubMedGoogle Scholar
  73. 73.
    Romer T, Bojahr B, Schwesinger G (2002) Treatment of a torqued hematosalpinx in the thirteenth week of pregnancy using gasless laparoscopy. J Am Assoc Gynecol Laparosc 9(1):89–92PubMedCrossRefGoogle Scholar
  74. 74.
    Melgrati L et al (2005) Isobaric (gasless) laparoscopic myomectomy during pregnancy. J Minim Invasive Gynecol 12(4):379–381PubMedCrossRefGoogle Scholar
  75. 75.
    Matsumoto T et al (1999) Laparoscopic treatment of uterine prolapse during pregnancy. Obstet Gynecol 93(5 Pt 2):849PubMedCrossRefGoogle Scholar
  76. 76.
    Oguri H, Taniguchi K, Fukaya T (2005) Gasless laparoscopic management of ovarian cysts during pregnancy. Int J Gynaecol Obstet 91(3):258–259PubMedCrossRefGoogle Scholar
  77. 77.
    Iafrati MD, Yarnell R, Schwaitzberg SD (1995) Gasless laparoscopic cholecystectomy in pregnancy. J Laparoendosc Surg 5(2):127–130PubMedGoogle Scholar
  78. 78.
    Hume RF, Killiam AP (1990) Maternal physiology, in obstetrics and gynecology. In: Scott JR, KiSaia J, Hammon DB (eds) JB Lippincott, Philadelphia, pp 93–100Google Scholar
  79. 79.
    Society of American Gastrointestinal Endoscopic Surgeons (SAGES) (1998) Guidelines for laparoscopic surgery during pregnancy. Surg Endosc 12(2):189–190CrossRefGoogle Scholar
  80. 80.
    Hunter JG, Swanstrom L, Thornburg K (1995) Carbon dioxide pneumoperitoneum induces fetal acidosis in a pregnant ewe model. Surg Endosc 9(3):272–227; discussion 277–9PubMedCrossRefGoogle Scholar
  81. 81.
    Reedy MB et al (1995) Maternal and fetal effects of laparoscopic insufflation in the gravid baboon. J Am Assoc Gynecol Laparosc 2(4):399–406PubMedCrossRefGoogle Scholar
  82. 82.
    Curet MJ et al (1996) Effects of CO2 pneumoperitoneum in pregnant ewes. J Surg Res 63(1):339–344PubMedCrossRefGoogle Scholar
  83. 83.
    Barnard JM et al (1995) Fetal response to carbon dioxide pneumoperitoneum in the pregnant ewe. Obstet Gynecol 85(5 Pt 1):669–674PubMedCrossRefGoogle Scholar
  84. 84.
    Cruz AM et al (1996) Intraabdominal carbon dioxide insufflation in the pregnant ewe. Uterine blood flow, intraamniotic pressure, and cardiopulmonary effects. Anesthesiology 85(6):1395–1402PubMedCrossRefGoogle Scholar
  85. 85.
    Soper NJ, Hunter JG, Petrie RH (1992) Laparoscopic cholecystectomy during pregnancy. Surg Endosc 6(3):115–117PubMedCrossRefGoogle Scholar
  86. 86.
    Comitalo JB, Lynch D (1994) Laparoscopic cholecystectomy in the pregnant patient. Surg Laparosc Endosc 4(4):268–271PubMedGoogle Scholar
  87. 87.
    Bhavani-Shankar K et al (2000) Arterial to end-tidal carbon dioxide pressure difference during laparoscopic surgery in pregnancy. Anesthesiology 93(2):370–373PubMedCrossRefGoogle Scholar
  88. 88.
    Melnick DM, Wahl WL, Dalton VK (2004) Management of general surgical problems in the pregnant patient. Am J Surg 187(2):170–180PubMedCrossRefGoogle Scholar
  89. 89.
    Jorgensen JO et al (1994) Venous stasis during laparoscopic cholecystectomy. Surg Laparosc Endosc 4(2):128–133PubMedGoogle Scholar
  90. 90.
    Thromboembolic Risk Factors (THRIFT) Consensus Group (1992) Risk of and prophylaxis for venous thromboembolism in hospital patients. BMJ 305(6853):567–574CrossRefGoogle Scholar
  91. 91.
    Casele HL (2006) The use of unfractionated heparin and low molecular weight heparins in pregnancy. Clin Obstet Gynecol 49(4):895–905PubMedCrossRefGoogle Scholar
  92. 92.
    Hiatt JR et al (1986) Biliary disease in pregnancy: strategy for surgical management. Am J Surg 151(2):263–265PubMedCrossRefGoogle Scholar
  93. 93.
    Ghumman E, Barry M, Grace PA (1997) Management of gallstones in pregnancy. Br J Surg 84(12):1646–1650PubMedCrossRefGoogle Scholar
  94. 94.
    Chamogeorgakis T et al (1999) Laparoscopic cholecystectomy during pregnancy: three case reports. JSLS 3(1):67–69PubMedGoogle Scholar
  95. 95.
    Steinbrook RA, Brooks DC, Datta S (1996) Laparoscopic cholecystectomy during pregnancy. Review of anesthetic management, surgical considerations. Surg Endosc 10(5):511–515PubMedCrossRefGoogle Scholar
  96. 96.
    Scott LD (1992) Gallstone disease and pancreatitis in pregnancy. Gastroenterol Clin North Am 21(4):803–815PubMedGoogle Scholar
  97. 97.
    Printen KJ, Ott RA (1978) Cholecystectomy during pregnancy. Am Surg 44(7):432–424PubMedGoogle Scholar
  98. 98.
    Graham G, Baxi L, Tharakan T (1998) Laparoscopic cholecystectomy during pregnancy: a case series and review of the literature. Obstet Gynecol Surv 53(9):566–574PubMedCrossRefGoogle Scholar
  99. 99.
    DeVore GR (1980) Acute abdominal pain in the pregnant patient due to pancreatitis, acute appendicitis, cholecystitis, or peptic ulcer disease. Clin Perinatol 7(2):349–369PubMedGoogle Scholar
  100. 100.
    Borum ML (1998) Hepatobiliary diseases in women. Med Clin North Am 82(1):51–75PubMedCrossRefGoogle Scholar
  101. 101.
    Tuech JJ et al (2000) Management of choledocholithiasis during pregnancy by magnetic resonance cholangiography and laparoscopic common bile duct stone extraction. Surg Laparosc Endosc Percutan Tech 10(5):323–325PubMedCrossRefGoogle Scholar
  102. 102.
    Baillie J et al (1990) Endoscopic management of choledocholithiasis during pregnancy. Surg Gynecol Obstet 171(1):1–4PubMedGoogle Scholar
  103. 103.
    Sungler P et al (2000) Laparoscopic cholecystectomy and interventional endoscopy for gallstone complications during pregnancy. Surg Endosc 14(3):267–271PubMedCrossRefGoogle Scholar
  104. 104.
    Cosenza CA et al (1999) Surgical management of biliary gallstone disease during pregnancy. Am J Surg 178(6):545–548PubMedCrossRefGoogle Scholar
  105. 105.
    Barthel JS, Chowdhury T, Miedema BW (1998) Endoscopic sphincterotomy for the treatment of gallstone pancreatitis during pregnancy. Surg Endosc 12(5):394–399PubMedCrossRefGoogle Scholar
  106. 106.
    Scapa E (1995) To do or not to do an endoscopic retrograde cholangiopancreatography in acute biliary pancreatitis? Surg Laparosc Endosc 5(6):453–454PubMedGoogle Scholar
  107. 107.
    Andreoli M et al (1996) Laparoscopic cholecystectomy for recurrent gallstone pancreatitis during pregnancy. South Med J 89(11):1114–1115PubMedCrossRefGoogle Scholar
  108. 108.
    Schwartzberg BS, Conyers JA, Moore JA (1997) First trimester of pregnancy laparoscopic procedures. Surg Endosc 11(12):1216–1217PubMedCrossRefGoogle Scholar
  109. 109.
    Thomas SJ, Brisson P (1998) Laparoscopic appendectomy and cholecystectomy during pregnancy: six case reports. JSLS 2(1):41–46PubMedGoogle Scholar
  110. 110.
    Barnes SL et al (2004) Laparoscopic appendectomy after 30 weeks pregnancy: report of two cases and description of technique. Am Surg 70(8):733–736PubMedGoogle Scholar
  111. 111.
    de Perrot M et al (2000) Laparoscopic appendectomy during pregnancy. Surg Laparosc Endosc Percutan Tech 10(6):368–371PubMedCrossRefGoogle Scholar
  112. 112.
    Schreiber JH (1990) Laparoscopic appendectomy in pregnancy. Surg Endosc 4(2):100–102PubMedCrossRefGoogle Scholar
  113. 113.
    Mazze RI, Kallen B (1991) Appendectomy during pregnancy: a Swedish registry study of 778 cases. Obstet Gynecol 77(6):835–840PubMedGoogle Scholar
  114. 114.
    Cunningham FG, McCubbin JH (1975) Appendicitis complicating pregnancy. Obstet Gynecol 45(4):415–420PubMedGoogle Scholar
  115. 115.
    Andersen B, Nielsen TF (1999) Appendicitis in pregnancy: diagnosis, management and complications. Acta Obstet Gynecol Scand 78(9):758–762PubMedCrossRefGoogle Scholar
  116. 116.
    Horowitz MD et al (1985) Acute appendicitis during pregnancy. Diagnosis and management. Arch Surg 120(12):1362–1367PubMedGoogle Scholar
  117. 117.
    Mourad J et al (2000) Appendicitis in pregnancy: new information that contradicts long-held clinical beliefs. Am J Obstet Gynecol 182(5):1027–1029PubMedCrossRefGoogle Scholar
  118. 118.
    Mahmoodian S (1992) Appendicitis complicating pregnancy. South Med J 85(1):19–24PubMedGoogle Scholar
  119. 119.
    Cappell MS, Friedel D (2003) Abdominal pain during pregnancy. Gastroenterol Clin North Am 32(1):1–58PubMedCrossRefGoogle Scholar
  120. 120.
    Tamir IL, Bongard FS, Klein SR (1990) Acute appendicitis in the pregnant patient. Am J Surg 160(6):571–575; discussion 575–6PubMedCrossRefGoogle Scholar
  121. 121.
    Weingold AB (1983) Appendicitis in pregnancy. Clin Obstet Gynecol 26(4):801–809PubMedCrossRefGoogle Scholar
  122. 122.
    Shalhav AL et al (2000) Laparoscopic adrenalectomy for primary hyperaldosteronism during pregnancy. J Laparoendosc Adv Surg Tech A 10(3):169–171PubMedGoogle Scholar
  123. 123.
    Finkenstedt G et al (1999) Pheochromocytoma and sub-clinical Cushing’s syndrome during pregnancy: diagnosis, medical pre-treatment and cure by laparoscopic unilateral adrenalectomy. J Endocrinol Invest 22(7):551–557PubMedGoogle Scholar
  124. 124.
    Aishima M et al (2000) Retroperitoneal laparoscopic adrenalectomy in a pregnant woman with Cushing’s syndrome. J Urol 164(3 Pt 1):770–771PubMedGoogle Scholar
  125. 125.
    Lo CY, Lo CM, Lam KY (2002) Cushing’s syndrome secondary to adrenal adenoma during pregnancy. Surg Endosc 16(1):219–220PubMedGoogle Scholar
  126. 126.
    Janetschek G et al (1998) Laparoscopic surgery for pheochromocytoma: adrenalectomy, partial resection, excision of paragangliomas. J Urol 160(2):330–334PubMedCrossRefGoogle Scholar
  127. 127.
    Demeure MJ et al (1998) Laparoscopic removal of a right adrenal pheochromocytoma in a pregnant woman. J Laparoendosc Adv Surg Tech A 8(5):315–319PubMedGoogle Scholar
  128. 128.
    Pace DE et al (2002) Minimally invasive adrenalectomy for pheochromocytoma during pregnancy. Surg Laparosc Endosc Percutan Tech 12(2):122–125PubMedCrossRefGoogle Scholar
  129. 129.
    Gagner M et al (1996) Is laparoscopic adrenalectomy indicated for pheochromocytomas? Surgery 120(6):1076–1079; discussion 1079–1080PubMedCrossRefGoogle Scholar
  130. 130.
    Wolf A et al (2004) Pheochromocytoma during pregnancy: laparoscopic and conventional surgical treatment of two cases. Exp Clin Endocrinol Diabetes 112(2):98–101PubMedCrossRefGoogle Scholar
  131. 131.
    Kim PT et al (2006) Laparoscopic adrenalectomy for pheochromocytoma in pregnancy. Can J Surg 49(1):62–63PubMedGoogle Scholar
  132. 132.
    Griffiths J et al (2005) Laparoscopic splenectomy for the treatment of refractory immune thrombocytopenia in pregnancy. J Obstet Gynaecol Can 27(8):771–774PubMedGoogle Scholar
  133. 133.
    Hardwick RH et al (1999) Laparoscopic splenectomy in pregnancy. J Laparoendosc Adv Surg Tech A 9(5):439–440PubMedGoogle Scholar
  134. 134.
    Allran CF Jr, Weiss CA 3rd, Park AE (2002) Urgent laparoscopic splenectomy in a morbidly obese pregnant woman: case report and literature review. J Laparoendosc Adv Surg Tech A 12(6):445–447PubMedCrossRefGoogle Scholar
  135. 135.
    Iwase K et al (2001) Hand-assisted laparoscopic splenectomy for idiopathic thrombocytopenic purpura during pregnancy. Surg Laparosc Endosc Percutan Tech 11(1):53–56PubMedCrossRefGoogle Scholar
  136. 136.
    Anglin BV et al (2001) Immune thrombocytopenic purpura during pregnancy: laparoscopic treatment. JSLS 5(1):63–67PubMedGoogle Scholar
  137. 137.
    O’Connor JP et al (2004) Laparoscopic nephrectomy for renal-cell carcinoma during pregnancy. J Endourol 18(9):871–874PubMedCrossRefGoogle Scholar
  138. 138.
    Sainsbury DC et al (2004) Laparoscopic radical nephrectomy in first-trimester pregnancy. Urology 64(6):1231 e7–8PubMedCrossRefGoogle Scholar
  139. 139.
    Bozzo M, Buscaglia M, Ferrazzi E (1997) The management of persistent adnexal masses in pregnancy. Am J Obstet Gynecol 177(4):981–982PubMedCrossRefGoogle Scholar
  140. 140.
    Thornton JG, Wells M (1987) Ovarian cysts in pregnancy: does ultrasound make traditional management inappropriate? Obstet Gynecol 69(5):717–21PubMedGoogle Scholar
  141. 141.
    Grimes WH Jr et al (1954) Ovarian cyst complicating pregnancy. Am J Obstet Gynecol 68(2):594–605PubMedGoogle Scholar
  142. 142.
    Sherard GB 3rd et al (2003) Adnexal masses and pregnancy: a 12-year experience. Am J Obstet Gynecol 189(2):358–362; discussion 362–3PubMedCrossRefGoogle Scholar
  143. 143.
    Hess LW et al (1988) Adnexal mass occurring with intrauterine pregnancy: report of fifty-four patients requiring laparotomy for definitive management. Am J Obstet Gynecol 158(5):1029–1034PubMedGoogle Scholar
  144. 144.
    Schmeler KM et al (2005) Adnexal masses in pregnancy: surgery compared with observation. Obstet Gynecol 105(5 Pt 1):1098–1103PubMedGoogle Scholar
  145. 145.
    Zanetta G et al (2003) A prospective study of the role of ultrasound in the management of adnexal masses in pregnancy. BJOG 110(6):578–583PubMedCrossRefGoogle Scholar
  146. 146.
    Condous G et al (2004) Should we be examining the ovaries in pregnancy? Prevalence and natural history of adnexal pathology detected at first-trimester sonography. Ultrasound Obstet Gynecol 24(1):62–66PubMedCrossRefGoogle Scholar
  147. 147.
    ACOG Practice Bulletin (2007) Management of adnexal masses. Obstet Gynecol 110(1):201–214Google Scholar
  148. 148.
    Nezhat F et al (1991) Laparoscopic ovarian cystectomy during pregnancy. J Laparoendosc Surg 1(3):161–164PubMedGoogle Scholar
  149. 149.
    Parker WH et al (1994) A multicenter study of laparoscopic management of selected cystic adnexal masses in postmenopausal women. J Am Coll Surg 179(6):733–737PubMedGoogle Scholar
  150. 150.
    Tazuke SI et al (1997) Laparoscopic management of pelvic pathology during pregnancy. J Am Assoc Gynecol Laparosc 4(5):605–608PubMedCrossRefGoogle Scholar
  151. 151.
    Chung MK, Chung RP (2001) Laparoscopic extracorporeal oophorectomy and ovarian cystectomy in second trimester pregnant obese patients. JSLS 5(3):273–277PubMedGoogle Scholar
  152. 152.
    Yuen PM, Chang AM (1997) Laparoscopic management of adnexal mass during pregnancy. Acta Obstet Gynecol Scand 76(2):173–176PubMedCrossRefGoogle Scholar
  153. 153.
    Loh FH et al (1998) Case report of ruptured endometriotic cyst in pregnancy treated by laparoscopic ovarian cystectomy. Singapore Med J 39(8):368–369PubMedGoogle Scholar
  154. 154.
    Stepp KJ et al (2003) Laparoscopy for adnexal masses in the second trimester of pregnancy. J Am Assoc Gynecol Laparosc 10(1):55–59PubMedCrossRefGoogle Scholar
  155. 155.
    Neiswender LL, Toub DB (1997) Laparoscopic excision of pelvic masses during pregnancy. J Am Assoc Gynecol Laparosc 4(2):269–272PubMedCrossRefGoogle Scholar
  156. 156.
    Yuen PM et al (2004) Outcome in laparoscopic management of persistent adnexal mass during the second trimester of pregnancy. Surg Endosc 18(9):1354–1357PubMedCrossRefGoogle Scholar
  157. 157.
    Parker J et al (1995) Laparoscopic adnexal surgery during pregnancy: a case of heterotopic tubal pregnancy treated by laparoscopic salpingectomy. Aust N Z J Obstet Gynaecol 35(2):208–210PubMedCrossRefGoogle Scholar
  158. 158.
    Moore RD, Smith WG (1999) Laparoscopic management of adnexal masses in pregnant women. J Reprod Med 44(2):97–100PubMedGoogle Scholar
  159. 159.
    Lin YH et al (2003) Successful laparoscopic management of a huge ovarian tumor in the 27th week of pregnancy. A case report. J Reprod Med 48(10):834–836Google Scholar
  160. 160.
    Mathevet P et al (2003) Laparoscopic management of adnexal masses in pregnancy: a case series. Eur J Obstet Gynecol Reprod Biol 108(2):217–222PubMedGoogle Scholar
  161. 161.
    Struyk AP, Treffers PE (1984) Ovarian tumors in pregnancy. Acta Obstet Gynecol Scand 63(5):421–424PubMedCrossRefGoogle Scholar
  162. 162.
    Nichols DH, Julian PJ (1985) Torsion of the adnexa. Clin Obstet Gynecol 28(2):375–380PubMedGoogle Scholar
  163. 163.
    Mage G et al (1989) Laparoscopic management of adnexal torsion. A review of 35 cases. J Reprod Med 34(8):520–524PubMedGoogle Scholar
  164. 164.
    Garzarelli S, Mazzuca N (1994) One laparoscopic puncture for treatment of ovarian cysts with adnexal torsion in early pregnancy. A report of two cases. J Reprod Med 39(12):985–986PubMedGoogle Scholar
  165. 165.
    Morice P et al (1997) Laparoscopy for adnexal torsion in pregnant women. J Reprod Med 42(7):435–439PubMedGoogle Scholar
  166. 166.
    Abu-Musa A et al (2001) Laparoscopic unwinding and cystectomy of twisted dermoid cyst during second trimester of pregnancy. J Am Assoc Gynecol Laparosc 8(3):456–464PubMedCrossRefGoogle Scholar
  167. 167.
    Bassil S, Steinhart U, Donnez J (1999) Successful laparoscopic management of adnexal torsion during week 25 of a twin pregnancy. Hum Reprod 14(3):855–857PubMedCrossRefGoogle Scholar
  168. 168.
    Argenta PA et al (2000) Torsion of the uterine adnexa. Pathologic correlations and current management trends. J Reprod Med 45(10):831–836PubMedGoogle Scholar
  169. 169.
    Tarraza HM, Moore RD (1997) Gynecologic causes of the acute abdomen and the acute abdomen in pregnancy. Surg Clin North Am 77(6):1371–139PubMedCrossRefGoogle Scholar
  170. 170.
    Oelsner G et al (1993) Long-term follow-up of the twisted ischemic adnexa managed by detorsion. Fertil Steril 60(6):976–979PubMedGoogle Scholar
  171. 171.
    Sharp HT (2002) The acute abdomen during pregnancy. Clin Obstet Gynecol 45(2):405–413PubMedCrossRefGoogle Scholar
  172. 172.
    Katz VL, Farmer RM (1999) Controversies in tocolytic therapy. Clin Obstet Gynecol 42(4):802–1819PubMedCrossRefGoogle Scholar
  173. 173.
    Berkman ND et al (2003) Tocolytic treatment for the management of preterm labor: a review of the evidence. Am J Obstet Gynecol 188(6):1648–1659PubMedCrossRefGoogle Scholar
  174. 174.
    Tan TC et al (2006) Tocolytic treatment for the management of preterm labour: a systematic review. Singapore Med J 47(5):361–366PubMedGoogle Scholar
  175. 175.
    Romero R et al (2000) An oxytocin receptor antagonist (atosiban) in the treatment of preterm labor: a randomized, double-blind, placebo-controlled trial with tocolytic rescue. Am J Obstet Gynecol 182(5):1173–1183PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Heidi Jackson
    • 1
  • Steven Granger
    • 1
  • Raymond Price
    • 2
    Email author
  • Michael Rollins
    • 3
  • David Earle
    • 4
  • William Richardson
    • 5
  • Robert Fanelli
    • 6
  1. 1.Department of SurgeryUniversity of Utah Medical CenterSalt Lake CityUSA
  2. 2.Department of SurgeryIntermountain Medical Center, Intermountain HealthcareSalt Lake CityUSA
  3. 3.Department of SurgeryPrimary Children’s Medical Center, Intermountain HealthcareSalt Lake CityUSA
  4. 4.Department of SurgeryBaystate Medical CenterSpringfieldUSA
  5. 5.Department of SurgeryOchsner Clinic FoundationNew OrleansUSA
  6. 6.Department of SurgeryBerkshire Medical CenterPittsfieldUSA

Personalised recommendations