Abstract
Objective: Evaluation of the fetal effects of laparoscopic surgery during pregnancy
Design: Case series
Setting: Department of Obstetrics and Gynecology, Osaka City Sumiyoshi Hospital
Patients: Twelve pregnant women who underwent laparoscopic surgery because of an adnexal mass in the first trimester. In six women, uterine artery resistant index (RI), umbilical artery and fetal heart rate were measured.
Interventions: Laparoscopic surgery (anesthesia and pneumopetioneum).
Main outcome measures: Maternal complications, pregnancy loss, as well as intraoperative fetal heart rate and umbilical artery RI.
Results: Gestational age ranged from 9 to 14 weeks, mean operative time was 100 minutes (range: 51- 140 minutes), mean anesthesia time was 146 minutes (range: 76-190 minutes), pneumoperitoneum pressure was ≤8 mm Hg, mean pneumoperitoneum time was 43 minutes (17-69 minutes), and mean duration of tocolysis was 5 days (range: 3-8 days). During laparoscopic surgery, the fetal heart rate remained normal, but umbilical artery RI increased. Mean umbilical artery RI increased was 0.070 mm Hg after induction of anesthesia and further increased by 0.015 mm Hg after the establishment of a pneumoperitoneum. Mean uterine artery RI decrease after induction of anesthesia was 0.220 mm Hg; however, it increased 0.110 mm Hg after establishment of pneumoperitoneum. Fetal heart rate remained in normal. All pregnancy outcomes were normal.
Conclusions: Laparoscopic surgery in pregnancy incurred no maternal complications. However, fetal distress may occur during the procedure. Thus, it is prudent to minimize the duration of anesthesia and pneumoperitoneum.
