Approach to the acute abdomen in pregnancy.

Numerous physiologic changes in pregnancy may affect the presentation of abdominal pain in pregnancy. A high index of suspicion must be used when evaluating a pregnant patient with abdominal pain. General anesthesia is considered safe in pregnancy. Intraoperative monitoring and tocolytics should be individualized. Laparoscopic surgery should be performed in the second trimester when possible and appears as safe as laparotomy. If indicated, diagnostic imaging should not be withheld from the pregnant patient. Appendectomy and cholecystectomy appear to be safe in pregnancy. The reported incidence of adnexal masses and fibroids in pregnancy may increase with increasing use of first-trimester ultrasound. Conservative management, with surgical management postpartum, appears reasonable in most cases.