Respiratory

Alterations in the chest wall configuration and the diaphragm during pregnancy cause a restrictive pulmonary physiology. Minute ventilation increases throughout pregnancy to become almost 50% above normal at term (25). Pregnant patients are vulnerable to arterial oxygen desaturation secondary to the decreased residual lung volume and functional residual capacity caused by upward displacement of the diaphragm (26).

The upward displacement of the diaphragm is increased by CO2 pneumoperitoneum. This has led to the recommendation that intra-abdominal pressures should be minimized during laparoscopic surgery with pressures less than 12 mmHg (27).

However, other authors have stressed the importance of adequate visualization of the intra-abdominal cavity and have used pressures up to 15 mmHg without increasing the incidence of adverse effects to either the mother or the fetus (12,13).

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