Recommendations

More information has accumulated recently as laparoscopy has become more common during pregnancy. However, most of the data is found in case series and retrospective reviews, which limits the ability to provide absolute guidelines. Further controlled clinical studies are needed to clarify these guidelines, and revision may be necessary as new data appear. The current recommendations for laparoscopy during surgery are summarized in the following:

■ Operative intervention may be performed in any trimester if warranted by the patient's condition.

■ Pneumatic compression devices should be utilized.

■ Fetal heart tones should be monitored pre- and postoperatively.

■ Lead shielding and brief shots of fluoroscopy may be used judiciously.

■ Either the Hasson or Verres technique may be used for initial abdominal cannulation depending on surgeon preference and level of comfort with each technique.

■ Dependent positioning should be utilized to shift the uterus off of the inferior vena cava and the aorta.

■ Pneumoperitoneum pressure should be kept between 10 and 15 mmHg.

■ Obstetrics consultation should be obtained preoperatively.

■ Maternal end tidal CO2 should be maintained between 30 and 40 mmHg.

■ Tocolytics should be used for perceived or documented uterine contractions.

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