الفهرس 
Anatomical and Physiological Changes During PregnancyOnly 14 pages are availabe for public view
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Abstract
Acute abdomen in pregnancy remains one of the most challenging diagnostic and therapeutic dilemmas today. This is because of physiological and anatomical changes of pregnancy which alter the clinical presentation.
The incidence of acute abdomen in pregnancy ranges from 1 to 2%. The most common causes are acute appendicitis, cholecystitis, intestinal obstruction, perforated viscus and others.
In the past, pregnancy was considered as an absolute contraindication to laparoscopy. Recently laparoscopy is considered as an effective modality in treatment. Benefits of laparoscopic surgery compared to the traditional open surgery include a shorter hospital Stay, complete visualization of peritoneal cavity, improved cosmoses and a reduced rate of post-operative complications.
Laparoscopic surgery widely used in the last 3 decades by both gynecologists and general surgeons, but possible complications, such as uterine injury, difficulty during procedure, increased intra-abdominal pressure and CO2 absorption by the fetus and effect of the pneumoperitoneum on the maternal haemodynamic should be considered seriously.
Laparoscopic surgery can be performed safely during pregnancy, but with special precautions include an open Hasson technique. Keeping pneumoperitoneum pressure below 12 mmHg, Maternal end tidal CO2 monitoring and Port site locations should be adapted to the gestational age.
The fetal and maternal risks are governed by the stage of the pregnancy. During the first trimester of pregnancy, there is increased risk of miscarriage. The third trimester carries increase risk of preterm labour and poses unique technical difficulties due to the enlarged gravid uteru. Conversely, in the second trimester, the risk of miscarriage, teratogenesis and preterm labour are minimal and the gravid uterus does not create an obstruction. For these reasons, the second trimester is considered the safest.
Finally, management should entail multi-disciplinary team formed of a well experienced surgeon, obstetrician and anesthesiologist to ensure safety of both mother and fetus.