Incidental fetoscopy during laparoscopy in pregnancy: management of perforation of the gravid uterus.

INTRODUCTION

Laparoscopy during pregnancy is safe and effective, but poses unique challenges because of alterations in the intra-abdominal anatomy induced by the gravid uterus.

CASE: A 33-year-old female with an intrauterine pregnancy at 19 weeks' gestation presented with symptoms of appendicitis. Diagnostic laparoscopy resulted in incidental uterine perforation and insufflation. Transition to midline laparotomy was made to suture uterine puncture sites from the trocar and Veress needle. Preterm premature rupture of membranes and abruption were diagnosed at 32 weeks' gestation, and the patient was delivered. The child was alive and well at 12 months of age.

CONCLUSIONS

Lessons from the emerging field of minimally invasive fetal surgery regarding the management of surgical entry into the gravid uterus can be applied to the rare case of incidental uterine perforation at the time of laparoscopy during pregnancy.